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General NPI Number Information
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NPI Number | 1710591383
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Entity Type | Organization
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Legal Business Name | SOUTH BAY COUNSELING, LLC
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 5995 DR MARTIN LUTHER KING JR ST S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-5541
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Country | US
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Telephone | 727-698-0624
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Fax | 727-867-2556
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Provider Business Mailing Address
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Address Line | 5995 DR MARTIN LUTHER KING JR ST S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-5541
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Country | US
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Telephone | 727-698-0624
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Fax | 727-867-2556
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JOHN ANDREW BELL
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Credential | LCSW
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Telephone | 727-698-0624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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