Provider Demographics
NPI:1255412011
Name:CENTER FOR INTEGRATED COUNSELING & NEUROPSYCHOLOGY
Entity type:Organization
Organization Name:CENTER FOR INTEGRATED COUNSELING & NEUROPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TETEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CAP
Authorized Official - Phone:813-792-2121
Mailing Address - Street 1:8473 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3729
Mailing Address - Country:US
Mailing Address - Phone:813-792-2121
Mailing Address - Fax:813-792-2122
Practice Address - Street 1:8473 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3729
Practice Address - Country:US
Practice Address - Phone:813-792-2121
Practice Address - Fax:813-792-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW74291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8838Medicare ID - Type Unspecified