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General NPI Number Information
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NPI Number | 1487950887
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Entity Type | Individual
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Provider Name | ANTHONY BOBO
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Gender | Male
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 7501 OKEECHOBEE CT
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-7345
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Country | US
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Telephone | 330-573-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 7501 OKEECHOBEE CT
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-7345
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Country | US
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Telephone | 330-573-4722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | SS1069
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS1069
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License Number State | FL
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