Provider Demographics
NPI:1194364844
Name:HEROIC HEALTH GROUP LLC
Entity Type:Organization
Organization Name:HEROIC HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-386-9549
Mailing Address - Street 1:PO BOX 2525
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779
Mailing Address - Country:US
Mailing Address - Phone:727-386-9549
Mailing Address - Fax:727-289-5504
Practice Address - Street 1:6701 49TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5728
Practice Address - Country:US
Practice Address - Phone:727-386-9549
Practice Address - Fax:727-592-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-29
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty