Basic Information
| Provider Information | |||||||||
| NPI: | 1699155184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EXCEEN | ||||||||
| FirstName: | CHAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8002 KING HELIE BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346531435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278414430 | ||||||||
| FaxNumber: | 7278414430 | ||||||||
| Practice Location | |||||||||
| Address1: | 8002 KING HELIE BLVD. | ||||||||
| Address2: | BAYCARE BEHAVIORAL HEALTH | ||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278414430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2015 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 13415 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.