Provider Demographics
NPI:1881719250
Name:BRANDON ASSESSMENT AND COUNSELING CENTER INC
Entity type:Organization
Organization Name:BRANDON ASSESSMENT AND COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ENLOE
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BILLINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-654-8916
Mailing Address - Street 1:1210 MILLENNIUM PKWY
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4896
Mailing Address - Country:US
Mailing Address - Phone:813-654-8916
Mailing Address - Fax:813-654-6952
Practice Address - Street 1:1210 MILLENNIUM PKWY
Practice Address - Street 2:SUITE 1030
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4896
Practice Address - Country:US
Practice Address - Phone:813-654-8916
Practice Address - Fax:813-654-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty