MEDICARE: FOUR SEASONS BEHAVIORAL HEALTH COLLABORATIVE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1073819850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR SEASONS BEHAVIORAL HEALTH COLLABORATIVE INC.

Provider Business Mailing Address
First Line	:	3107 N 50TH ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-2302
Country	:	US
Telephone Number	:	813-367-2316
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 N 50TH ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-2302
Country	:	US
Telephone Number	:	813-367-2316
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD BROWN
Credential	:
Telephone Number	:	813-367-2316

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	01/27/2011

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