Provider Demographics
NPI:1508178245
Name:THE SPRING OF TAMPA BAY
Entity Type:Organization
Organization Name:THE SPRING OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-247-5433
Mailing Address - Street 1:P.O. BOX 5147
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33675
Mailing Address - Country:US
Mailing Address - Phone:813-247-5433
Mailing Address - Fax:813-248-2141
Practice Address - Street 1:2810 N. 35 ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615
Practice Address - Country:US
Practice Address - Phone:813-247-5433
Practice Address - Fax:813-248-2141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SPRING OF TAMPA BAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty