MEDICARE: SOUTH TAMPA COUNSELING ASSOCIATES

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	106H00000X	Marriage & Family Therapist	MT1697	FL
2	1041C0700X	Clinical Social Worker	SW4509	FL

General Provider Information

NPI Number	:	1447382957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TAMPA COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	3839 W KENNEDY BLVD
Second Line	:	SUITE ONE
City	:	TAMPA
State	:	FL
Zip	:	33609-2719
Country	:	US
Telephone Number	:	813-350-9490
Fax Number	:	813-877-3839

Provider Business Practice Location Address
First Line	:	3839 W KENNEDY BLVD
Second Line	:	SUITE ONE
City	:	TAMPA
State	:	FL
Zip	:	33609-2719
Country	:	US
Telephone Number	:	813-350-9490
Fax Number	:	813-877-3839

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ERIC GREGORISCH
Credential	:	MS, LMFT
Telephone Number	:	813-350-9490

Provider Enumeration Date	:	03/10/2007
Last Update Date	:	09/11/2025

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