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General NPI Number Information
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NPI Number | 1659752640
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Entity Type | Organization
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Legal Business Name | FAMILY CENTER OF PSYCHOTHERAPY/PSYCHIATRY & EVALUATION
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 7345 INTERNATIONAL PL STE 109
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34240-8468
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Country | US
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Telephone | 941-702-9978
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Fax | 941-203-4822
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Provider Business Mailing Address
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Address Line | 7345 INTERNATIONAL PL STE 109
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34240-8468
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Country | US
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Telephone | 941-702-9978
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Fax | 941-203-4822
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | DR. TARA FILES-HALL
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Credential | PH.D.
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Telephone | 941-224-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME110691
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6987
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License Number State | FL
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