Provider Demographics
NPI:1063897262
Name:EXCELSIS BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:EXCELSIS BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ECONOMOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:855-473-4273
Mailing Address - Street 1:4144 N ARMENIA AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6400
Mailing Address - Country:US
Mailing Address - Phone:855-743-4273
Mailing Address - Fax:855-743-4273
Practice Address - Street 1:4144 N ARMENIA AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6400
Practice Address - Country:US
Practice Address - Phone:855-743-4273
Practice Address - Fax:855-743-4273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP1400008092OtherBEHAVIORAL HEATH CARE COMPANY