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General NPI Number Information
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NPI Number | 1811154933
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Entity Type | Organization
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Legal Business Name | TAMPA BAY ACADEMY
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 12012 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5631
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Country | US
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Telephone | 813-677-6700
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Fax | 813-671-3145
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Provider Business Mailing Address
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Address Line | 12012 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5631
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Country | US
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Telephone | 813-677-6700
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Fax | 813-671-3145
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. BOBBY JEAN COOPER
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Credential | LMHC
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Telephone | 813-677-6700
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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 | MH9004
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License Number State | FL
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