Provider Demographics
NPI:1528287877
Name:SAMARITAN COUNSELING CENTER OF TAMPA, INC
Entity type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF TAMPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MONSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:813-872-7186
Mailing Address - Street 1:2604 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4106
Mailing Address - Country:US
Mailing Address - Phone:813-872-7186
Mailing Address - Fax:
Practice Address - Street 1:2604 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4106
Practice Address - Country:US
Practice Address - Phone:813-872-7186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 0001384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty