Provider Demographics
NPI:1356656532
Name:PALM HARBOR CHRISTIAN COUNSELING CENTER OF TIMOTHY N. DALEY, PHD PA
Entity Type:Organization
Organization Name:PALM HARBOR CHRISTIAN COUNSELING CENTER OF TIMOTHY N. DALEY, PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE AND FAMILY THERAP
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-656-4575
Mailing Address - Street 1:2706 PALM HARBOR BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2643
Mailing Address - Country:US
Mailing Address - Phone:727-656-4575
Mailing Address - Fax:
Practice Address - Street 1:2706 PALM HARBOR BLVD STE 315
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2643
Practice Address - Country:US
Practice Address - Phone:727-656-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 814251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health