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General NPI Number Information
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NPI Number | 1720312762
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Entity Type | Organization
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Legal Business Name | SUNCOAST BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 40347 US HIGHWAY 19 N STE 103
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4841
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Country | US
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Telephone | 727-786-6839
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Fax | 727-772-8212
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Provider Business Mailing Address
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Address Line | 40347 US HIGHWAY 19 N STE 103
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4841
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Country | US
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Telephone | 727-786-6839
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Fax | 727-772-8212
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY M FULLER
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Credential | PHD, BCBA, LMHC,NBCC
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Telephone | 727-786-6839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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