Healthcare Provider Details

I. General information

NPI: 1851973523
Provider Name (Legal Business Name): TAMPA BAY COMMUNITY MENTAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12421 N FLORIDA AVE STE 201
TAMPA FL
33612-4277
US

IV. Provider business mailing address

12421 N FLORIDA AVE STE 201
TAMPA FL
33612-4277
US

V. Phone/Fax

Practice location:
  • Phone: 813-930-0999
  • Fax: 813-433-5626
Mailing address:
  • Phone: 813-930-0999
  • Fax: 813-433-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YADIRA PEGUERO MARIN
Title or Position: PRESIDENT
Credential:
Phone: 813-930-0999