Provider Demographics
NPI:1245241165
Name:HILLSBOROUGH COUNTY DEPT OF CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:HILLSBOROUGH COUNTY DEPT OF CHILDREN'S SERVICES
Other - Org Name:CLINICAL SERVICES DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL SERVICES DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:FURMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-264-3807
Mailing Address - Street 1:3110 CLAY MANGUM LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2501
Mailing Address - Country:US
Mailing Address - Phone:813-264-3807
Mailing Address - Fax:813-264-3872
Practice Address - Street 1:3110 CLAY MANGUM LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2501
Practice Address - Country:US
Practice Address - Phone:813-264-3807
Practice Address - Fax:813-264-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8006-24322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children