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2208 E. Henry Avenue Tampa FL 33610-4300 | |
| (813) 272-2878 | |
| (813) 231-7324 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2208 E. Henry Avenue, Tampa, Florida |
| Authorized Official Name and Position | Roaya Tyson (CEO) |
| Authorized Official Contact | 8132398069 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5707 N 22nd Street Tampa FL 33610-4300 Ph: (813) 239-8069 | 2208 E. Henry Avenue Tampa FL 33610-4300 Ph: (813) 272-2878 |
| NPI Number | 1336358555 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 09/06/2022 |
| Certification Date | 09/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336358555 | NPI | - | NPPES |
| 060272813 | Medicaid | FL |
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