Provider Demographics
NPI:1568593135
Name:NEW TAMPA COUNSELING AND MEDIATION, INC.
Entity Type:Organization
Organization Name:NEW TAMPA COUNSELING AND MEDIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LMFT
Authorized Official - Phone:813-504-0360
Mailing Address - Street 1:PO BOX 46458
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0104
Mailing Address - Country:US
Mailing Address - Phone:813-504-0360
Mailing Address - Fax:813-977-4120
Practice Address - Street 1:8907 REGENTS PARK DR
Practice Address - Street 2:SUITE 310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3401
Practice Address - Country:US
Practice Address - Phone:813-504-0360
Practice Address - Fax:813-977-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC 5109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty