Provider Demographics
NPI:1306377551
Name:EXPLORATION COUNSELING: THERAPY & BEHAVIOR MODIFICATION SERVICES
Entity Type:Organization
Organization Name:EXPLORATION COUNSELING: THERAPY & BEHAVIOR MODIFICATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TATESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-399-4605
Mailing Address - Street 1:9641 NORCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1849
Mailing Address - Country:US
Mailing Address - Phone:813-399-4605
Mailing Address - Fax:
Practice Address - Street 1:10335 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2795
Practice Address - Country:US
Practice Address - Phone:813-399-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669854857Medicaid