Provider Demographics
NPI:1568089829
Name:THE WELL COUNSELING SERVICES OF TAMPA BAY
Entity Type:Organization
Organization Name:THE WELL COUNSELING SERVICES OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-693-0654
Mailing Address - Street 1:20203 INDIAN ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3486
Mailing Address - Country:US
Mailing Address - Phone:813-693-0654
Mailing Address - Fax:813-441-7320
Practice Address - Street 1:19337 SHUMARD OAK DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7235
Practice Address - Country:US
Practice Address - Phone:813-693-0654
Practice Address - Fax:813-441-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty