Provider Demographics
NPI:1477005361
Name:IRBY INSTITUTE OF COUNSELING AND ASSESSMENT NEEDS
Entity Type:Organization
Organization Name:IRBY INSTITUTE OF COUNSELING AND ASSESSMENT NEEDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-279-4349
Mailing Address - Street 1:8703 TERRA OAKS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-5054
Mailing Address - Country:US
Mailing Address - Phone:813-279-4349
Mailing Address - Fax:
Practice Address - Street 1:8703 TERRA OAKS RD
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-5054
Practice Address - Country:US
Practice Address - Phone:813-279-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1293251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health