Provider Demographics
NPI:1265831804
Name:HEUN COMPREHENSIVE PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:HEUN COMPREHENSIVE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:TAMPA BAY PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, OPERATOR, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-343-0830
Mailing Address - Street 1:2102 W PLATT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1769
Mailing Address - Country:US
Mailing Address - Phone:813-343-0830
Mailing Address - Fax:813-489-5469
Practice Address - Street 1:2102 W PLATT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1769
Practice Address - Country:US
Practice Address - Phone:813-343-0830
Practice Address - Fax:813-489-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8953103T00000X, 103TA0700X, 103TC0700X, 103TC1900X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty