Provider Demographics
NPI:1134691645
Name:PROFESSIONAL PSYCHOLOGY OF PINELLAS PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL PSYCHOLOGY OF PINELLAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN-BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-417-2812
Mailing Address - Street 1:12360 66TH ST STE 930
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3434
Mailing Address - Country:US
Mailing Address - Phone:172-741-7281
Mailing Address - Fax:
Practice Address - Street 1:12360 66TH ST STE 930
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3434
Practice Address - Country:US
Practice Address - Phone:172-741-7281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)