Provider Demographics
NPI:1407982051
Name:CANTRELL, JOHN PAUL
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10549 N FLORIDA AVE STE G
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6707
Mailing Address - Country:US
Mailing Address - Phone:813-222-0746
Mailing Address - Fax:813-570-7939
Practice Address - Street 1:MENTAL HEALTH CARE INC
Practice Address - Street 2:5707 N 22ND STREET
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-272-2878
Practice Address - Fax:813-272-3766
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 10291041C0700X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist