Provider Demographics
NPI:1902519069
Name:TAMPA BAY BEHAVIOR & THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:TAMPA BAY BEHAVIOR & THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEINER
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-810-1498
Mailing Address - Street 1:3750 GUNN HWY STE 305
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8915
Mailing Address - Country:US
Mailing Address - Phone:813-810-1498
Mailing Address - Fax:
Practice Address - Street 1:3750 GUNN HWY STE 305
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8915
Practice Address - Country:US
Practice Address - Phone:813-810-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty