Provider Demographics
NPI:1073058921
Name:COUNSELING ASSOCIATES OF TAMPA BAY, LLC
Entity Type:Organization
Organization Name:COUNSELING ASSOCIATES OF TAMPA BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:908-415-0632
Mailing Address - Street 1:11736 NEWBERRY GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3902
Mailing Address - Country:US
Mailing Address - Phone:908-415-0632
Mailing Address - Fax:
Practice Address - Street 1:11736 NEWBERRY GROVE LOOP
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-3902
Practice Address - Country:US
Practice Address - Phone:908-415-0632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty