Basic Information
| Provider Information | |||||||||
| NPI: | 1366690422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL CONSULTING OF TAMPA BAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6951 PISTOL RANGE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132142000 | ||||||||
| FaxNumber: | 8132650218 | ||||||||
| Practice Location | |||||||||
| Address1: | 9225 BAY PLAZA BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134404933 | ||||||||
| FaxNumber: | 8132650218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 10/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | ULLRICH | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8138142000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.