Provider Demographics
NPI:1659781615
Name:TAMPA BAY CENTER FOR COGNITIVE BEHAVIOR THERAPY, INC
Entity Type:Organization
Organization Name:TAMPA BAY CENTER FOR COGNITIVE BEHAVIOR THERAPY, INC
Other - Org Name:TBCFORCBT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-480-8482
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-0014
Mailing Address - Country:US
Mailing Address - Phone:813-480-8482
Mailing Address - Fax:813-651-4402
Practice Address - Street 1:509 WILBUR ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5323
Practice Address - Country:US
Practice Address - Phone:813-480-8482
Practice Address - Fax:813-651-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ180VOtherBCBS