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General NPI Number Information
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NPI Number | 1104177948
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Entity Type | Organization
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Legal Business Name | ENLOE BRUCE BILLINGSLEY LCSW PA
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 1210 MILLENNIUM PKWY SUITE 1030
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City | BRANDON
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State | FL
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Zip | 33511-4896
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Country | US
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Telephone | 813-654-8916
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Fax | 813-654-6952
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Provider Business Mailing Address
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Address Line | 1210 MILLENNIUM PARKWAY SUITE 1030
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City | BRANDON
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State | FL
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Zip | 33511-4858
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Country | US
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Telephone | 813-654-8916
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Fax | 813-654-6952
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Authorized Official
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Title or Position | LCSW
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Name | ENLOE BRUCE BILLINGSLEY
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Credential | LCSW
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Telephone | 813-654-8916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SW0000194
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License Number State | FL
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