Provider Demographics
NPI:1710707526
Name:TAMPA BEHAVIOR HEALTH
Entity type:Organization
Organization Name:TAMPA BEHAVIOR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:SHADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-631-9623
Mailing Address - Street 1:124 KRAML DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0303
Mailing Address - Country:US
Mailing Address - Phone:630-631-9623
Mailing Address - Fax:630-290-0522
Practice Address - Street 1:7402 N 56TH ST STE 355
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7700
Practice Address - Country:US
Practice Address - Phone:630-631-9623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty