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General NPI Number Information
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NPI Number | 1720446909
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Entity Type | Organization
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Legal Business Name | COUNSELING SERVICES OF TAMPA BAY
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 13575 58TH ST N SUITE 230
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City | CLEARWATER
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State | FL
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Zip | 33760-3740
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Country | US
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Telephone | 727-314-1224
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Fax | 727-408-6811
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Provider Business Mailing Address
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Address Line | 13575 58TH ST N #188
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City | CLEARWATER
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State | FL
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Zip | 33760-3740
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Country | US
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Telephone | 727-314-1224
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Fax | 727-408-6811
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Authorized Official
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Title or Position | OWNER
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Name | TRACEY BOURNE
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Credential | L.M.HC.
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Telephone | 727-314-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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