Provider Demographics
NPI:1184097578
Name:TOUCHED BY AN ANGLE SUPPORT SERVICE
Entity type:Organization
Organization Name:TOUCHED BY AN ANGLE SUPPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-531-1545
Mailing Address - Street 1:9029 WESTCHESTER CIR
Mailing Address - Street 2:APT - A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1542
Mailing Address - Country:US
Mailing Address - Phone:813-531-1545
Mailing Address - Fax:
Practice Address - Street 1:9029 WESTCHESTER CIR
Practice Address - Street 2:APT - A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1542
Practice Address - Country:US
Practice Address - Phone:813-531-1545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA232011APD014251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health