Provider Demographics
NPI:1689320947
Name:SJS COMPREHENSIVE SERVICES LLC
Entity Type:Organization
Organization Name:SJS COMPREHENSIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAKITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:504-300-9377
Mailing Address - Street 1:19046 BRUCE B DOWNS BLVD STE 1430
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2434
Mailing Address - Country:US
Mailing Address - Phone:504-300-9377
Mailing Address - Fax:
Practice Address - Street 1:126 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:504-300-9377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)