1881719250 NPI number — BRANDON ASSESSMENT AND COUNSELING CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881719250 NPI number — BRANDON ASSESSMENT AND COUNSELING CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANDON ASSESSMENT AND COUNSELING CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881719250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1210 MILLENNIUM PKWY
Provider Second Line Business Mailing Address:
SUITE 1030
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511-4896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-654-8916
Provider Business Mailing Address Fax Number:
813-654-6952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 MILLENNIUM PKWY
Provider Second Line Business Practice Location Address:
SUITE 1030
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-4896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-654-8916
Provider Business Practice Location Address Fax Number:
813-654-6952
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BILLINGSLEY
Authorized Official First Name:
ENLOE
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
OWNER PRESIDENT CEO
Authorized Official Telephone Number:
813-654-8916

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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