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3104 Cherry Palm Dr Ste 201 Tampa FL 33619-8374 | |
| (813) 372-0235 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3104 Cherry Palm Dr Ste 201, Tampa, Florida |
| Authorized Official Name and Position | Adam Cohen (DIRECTOR OF CLINICAL SERVICES) |
| Authorized Official Contact | 4075067316 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1538 Mango FL 33550-1538 Ph: (813) 372-0235 | 3104 Cherry Palm Dr Ste 201 Tampa FL 33619-8374 Ph: (813) 372-0235 |
| NPI Number | 1356738603 |
|---|---|
| Provider Enumeration Date | 04/23/2015 |
| Last Update Date | 08/10/2024 |
| Certification Date | 08/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356738603 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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