Provider Demographics
NPI:1013902956
Name:THE CRISIS CENTER OF TAMPA BAY, INC.
Entity Type:Organization
Organization Name:THE CRISIS CENTER OF TAMPA BAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:ALLYSON
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-964-1964
Mailing Address - Street 1:ONE CRISIS CENTER PLAZA
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1238
Mailing Address - Country:US
Mailing Address - Phone:813-964-1964
Mailing Address - Fax:813-969-4950
Practice Address - Street 1:ONE CRISIS CENTER PLAZA
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1238
Practice Address - Country:US
Practice Address - Phone:813-964-1964
Practice Address - Fax:813-969-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FL85-8012527472C-9261Q00000X
85-8012527472C-9261Q00000X
85-8012527472C9261Q00000X
FLSW 63531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018148600Medicaid
FL088345003Medicaid