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509 Wilbur St Brandon FL 33511-5323 | |
| (813) 480-8482 | |
| (813) 651-4402 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 509 Wilbur St, Brandon, Florida |
| Authorized Official Name and Position | Nancy S Gordon (PRESIDENT) |
| Authorized Official Contact | 8134808482 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 14 Brandon FL 33509-0014 Ph: (813) 480-8482 | 509 Wilbur St Brandon FL 33511-5323 Ph: (813) 480-8482 |
| NPI Number | 1659781615 |
|---|---|
| Provider Enumeration Date | 04/30/2014 |
| Last Update Date | 04/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659781615 | NPI | - | NPPES |
| Z180V | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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