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General NPI Number Information
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NPI Number | 1770891715
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Entity Type | Organization
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Legal Business Name | BAY HARBOR BEHAVIORAL ASSOCIATES INC.
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 930 SNELL ISLE BLVD NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-3830
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Country | US
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Telephone | 727-743-3483
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Fax | 727-896-7272
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Provider Business Mailing Address
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Address Line | 930 SNELL ISLE BLVD NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-3830
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Country | US
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Telephone | 727-743-3483
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Fax | 727-896-7272
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Authorized Official
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Title or Position | CEO
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Name | MS. SARA GEDAJLOVIC
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Credential | MA, LMHC
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Telephone | 727-743-3483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | MH 3061
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License Number State | FL
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 3061
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License Number State | FL
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