Provider Demographics
NPI:1174886600
Name:BRANDON PSYCHIATRY AND COUNSELING
Entity type:Organization
Organization Name:BRANDON PSYCHIATRY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:SPANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:813-967-1376
Mailing Address - Street 1:401 N PARSONS AVE
Mailing Address - Street 2:SUITE 107 A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4538
Mailing Address - Country:US
Mailing Address - Phone:813-967-1376
Mailing Address - Fax:813-681-5958
Practice Address - Street 1:401 N PARSONS AVE
Practice Address - Street 2:SUITE 107 A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4538
Practice Address - Country:US
Practice Address - Phone:813-967-1376
Practice Address - Fax:813-681-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL473102084P0804X
FLBK42080162084A0401X
FLSW59791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty