Healthcare Provider Details

I. General information

NPI: 1699085258
Provider Name (Legal Business Name): MOTHERING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH HYDE PARK AVENUE SUITE 250
TAMPA FL
33606
US

IV. Provider business mailing address

300 SOUTH HYDE PARK AVENUE SUITE 250
TAMPA FL
33606
US

V. Phone/Fax

Practice location:
  • Phone: 813-431-0797
  • Fax:
Mailing address:
  • Phone: 813-431-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN LEIGH MAIER
Title or Position: DIRECTOR
Credential: LCSW
Phone: 813-431-0797