Provider Demographics
NPI:1073991816
Name:BEHAVIORAL CONSULTING OF TAMPA BAY
Entity Type:Organization
Organization Name:BEHAVIORAL CONSULTING OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:813-814-2000
Mailing Address - Street 1:6951 PISTOL RANGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9601
Mailing Address - Country:US
Mailing Address - Phone:813-814-2000
Mailing Address - Fax:813-814-2004
Practice Address - Street 1:6951 PISTOL RANGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9601
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:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health