Provider Demographics
NPI:1366690422
Name:BEHAVIORAL CONSULTING OF TAMPA BAY
Entity type:Organization
Organization Name:BEHAVIORAL CONSULTING OF TAMPA BAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-814-2000
Mailing Address - Street 1:14497 N. DALE MABRY
Mailing Address - Street 2:STE 115-N
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618
Mailing Address - Country:US
Mailing Address - Phone:813-814-2000
Mailing Address - Fax:813-814-2004
Practice Address - Street 1:14497 N. DALE MABRY
Practice Address - Street 2:STE 115-N
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-814-2000
Practice Address - Fax:813-814-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health