MEDICARE: SAMARITAN COUNSELING CENTER OF TAMPA, 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	101YM0800X	Mental Health Counselor	MH 0001384	FL

General Provider Information

NPI Number	:	1528287877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN COUNSELING CENTER OF TAMPA, INC

Provider Business Mailing Address
First Line	:	2604 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4106
Country	:	US
Telephone Number	:	813-872-7186
Fax Number	:

Provider Business Practice Location Address
First Line	:	2604 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4106
Country	:	US
Telephone Number	:	813-872-7186
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. JOHN VINCENT MONSOUR
Credential	:	D.MIN
Telephone Number	:	813-872-7186

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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