Provider Demographics
NPI:1235455999
Name:EPILEPSY SERVICES OF WEST CENTRAL FLORIDA
Entity Type:Organization
Organization Name:EPILEPSY SERVICES OF WEST CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-870-3414
Mailing Address - Street 1:4618 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2706
Mailing Address - Country:US
Mailing Address - Phone:813-870-3414
Mailing Address - Fax:831-870-1321
Practice Address - Street 1:4618 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2706
Practice Address - Country:US
Practice Address - Phone:813-870-3414
Practice Address - Fax:831-870-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty