Provider Demographics
NPI:1245579978
Name:APOLLO BEACH THERAPY, LLC
Entity Type:Organization
Organization Name:APOLLO BEACH THERAPY, LLC
Other - Org Name:MI COUNSELING OF NEW TAMPA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:INNOCENTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-494-8643
Mailing Address - Street 1:7342 PARKSHORE DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1566
Mailing Address - Country:US
Mailing Address - Phone:813-494-8643
Mailing Address - Fax:813-971-8508
Practice Address - Street 1:200 FRANDORSON CIR STE 205
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2691
Practice Address - Country:US
Practice Address - Phone:813-494-8643
Practice Address - Fax:813-494-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty