Provider Demographics
NPI:1306114301
Name:A AND R PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:A AND R PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-872-1525
Mailing Address - Street 1:2150 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:2ND FLOOR SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6551
Mailing Address - Country:US
Mailing Address - Phone:813-872-1525
Mailing Address - Fax:813-877-5910
Practice Address - Street 1:2150 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:2ND FLOOR SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6551
Practice Address - Country:US
Practice Address - Phone:813-872-1525
Practice Address - Fax:813-877-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty