| That's Crazy, Llc | |
|
330 Pauls Dr Ste 105 Brandon FL 33511-4801 | |
| (321) 948-4336 | |
| Not Available |
| Full Name | That's Crazy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 330 Pauls Dr Ste 105, Brandon, Florida |
| Authorized Official Name and Position | Ashley Rayshelle Lucas (LCSW) |
| Authorized Official Contact | 8134003212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| That's Crazy, Llc 12015 Stone Pine St Riverview FL 33569-5588 Ph: (321) 948-4336 | That's Crazy, Llc 330 Pauls Dr Ste 105 Brandon FL 33511-4801 Ph: (321) 948-4336 |
| NPI Number | 1780206029 |
|---|---|
| Provider Enumeration Date | 05/09/2020 |
| Last Update Date | 07/13/2022 |
| Certification Date | 07/13/2022 |
| Medicare PECOS PAC ID | 5193136257 |
|---|---|
| Medicare Enrollment ID | O20201120000365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780206029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ashley Rayshelle Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457912636 PECOS PAC ID: 6002227162 Enrollment ID: I20201120000468 |
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