=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881719250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRANDON ASSESSMENT AND COUNSELING CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 11/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 MILLENNIUM PKWY SUITE 1030
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-4896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-654-8916
-----------------------------------------------------
Fax | 813-654-6952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 MILLENNIUM PKWY SUITE 1030
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-4896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-654-8916
-----------------------------------------------------
Fax | 813-654-6952
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT CEO
-----------------------------------------------------
Name | ENLOE BRUCE BILLINGSLEY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 813-654-8916
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------