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9051 Florida Mining Blvd Ste 102 Tampa FL 33634-1240 | |
| (877) 350-5005 | |
| (847) 584-2604 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 9051 Florida Mining Blvd Ste 102, Tampa, Florida |
| Authorized Official Name and Position | Julie Bush (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8475842604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 631270 Cincinnati OH 45263-1270 Ph: (877) 350-5005 | 9051 Florida Mining Blvd Ste 102 Tampa FL 33634-1240 Ph: (877) 350-5005 |
| NPI Number | 1649413006 |
|---|---|
| Provider Enumeration Date | 04/15/2009 |
| Last Update Date | 09/14/2022 |
| Certification Date | 09/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649413006 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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