| Professional Psychology Of Pinellas Pllc | |
|
12360 66th St Ste 930 Largo FL 33773-3434 | |
| (172) 741-7281 | |
| Not Available |
| Full Name | Professional Psychology Of Pinellas Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12360 66th St Ste 930, Largo, Florida |
| Authorized Official Name and Position | Tia Kern-butler (OWNER) |
| Authorized Official Contact | 7274172812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Psychology Of Pinellas Pllc 12360 66th St Ste 930 Largo FL 33773-3434 Ph: (172) 741-7281 | Professional Psychology Of Pinellas Pllc 12360 66th St Ste 930 Largo FL 33773-3434 Ph: (172) 741-7281 |
| NPI Number | 1134691645 |
|---|---|
| Provider Enumeration Date | 12/20/2018 |
| Last Update Date | 12/20/2018 |
| Medicare PECOS PAC ID | 5799016747 |
|---|---|
| Medicare Enrollment ID | O20191007001450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134691645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tia Kern-butler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184637779 PECOS PAC ID: 7315072824 Enrollment ID: I20100322000760 |
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