Provider Demographics
NPI:1083000582
Name:MOBLEY, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E BAKER STREET #1001
Mailing Address - Street 2:H.E.A.D.S USA
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 E BAKER STREET #1001
Practice Address - Street 2:H.E.A.D.S USA
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:34450
Practice Address - Country:US
Practice Address - Phone:813-754-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor