Provider Demographics
NPI:1851973523
Name:TAMPA BAY COMMUNITY MENTAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:TAMPA BAY COMMUNITY MENTAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUERO MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-930-0999
Mailing Address - Street 1:12421 N FLORIDA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4277
Mailing Address - Country:US
Mailing Address - Phone:813-930-0999
Mailing Address - Fax:813-433-5626
Practice Address - Street 1:12421 N FLORIDA AVE STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4277
Practice Address - Country:US
Practice Address - Phone:813-930-0999
Practice Address - Fax:813-433-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)