MEDICARE: BAY AREA COUNSELING LLC

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	1041C0700X	Clinical Social Worker	SW4189	FL

General Provider Information

NPI Number	:	1730388455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA COUNSELING LLC

Provider Business Mailing Address
First Line	:	18913 FAIRWOOD CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1867
Country	:	US
Telephone Number	:	813-340-0744
Fax Number	:	813-972-2054

Provider Business Practice Location Address
First Line	:	14521 BRUCE B DOWNS BLVD STE 303
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-6500
Country	:	US
Telephone Number	:	813-340-0744
Fax Number	:	813-972-2054

Authorized Official
Title or Position	:	MEMBER
Name	:	LORRI S PARKER
Credential	:	LCSW
Telephone Number	:	813-340-0744

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	06/21/2022

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