1801320478 NPI number — PINNACLE ADHD COUNSELING LLC

Table of content: (NPI 1801320478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801320478 NPI number — PINNACLE ADHD COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE ADHD COUNSELING LLC
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:
1801320478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8884 FOUNCERS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-465-0686
Provider Business Mailing Address Fax Number:
727-623-4283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 18-G
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-4353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-465-0686
Provider Business Practice Location Address Fax Number:
727-623-4283
Provider Enumeration Date:
04/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DIXON-TALIAFERRO
Authorized Official First Name:
CARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-465-0686

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MH13626 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 017309800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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