Provider Demographics
NPI:1932074804
Name:VIVID BEHAVIORAL SCIENCES LLC
Entity type:Organization
Organization Name:VIVID BEHAVIORAL SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC
Authorized Official - Phone:813-773-2643
Mailing Address - Street 1:38176 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1380
Mailing Address - Country:US
Mailing Address - Phone:813-773-2643
Mailing Address - Fax:813-537-8833
Practice Address - Street 1:38176 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1380
Practice Address - Country:US
Practice Address - Phone:813-773-2643
Practice Address - Fax:813-537-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty