Provider Demographics
NPI:1417164997
Name:FLORIDA STATE UNIVERSITY
Entity Type:Organization
Organization Name:FLORIDA STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, EMPLOYEE ASSISTANCE PRGM
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PREVATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-644-2288
Mailing Address - Street 1:937 W. JEFFERSON ST.
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4190
Mailing Address - Country:US
Mailing Address - Phone:850-644-2288
Mailing Address - Fax:850-644-1043
Practice Address - Street 1:937 W. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4190
Practice Address - Country:US
Practice Address - Phone:850-644-2288
Practice Address - Fax:850-644-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty