Organization
NORTHSIDE MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELAINE CHURTON I LCSW (DIRECTOR)
(813) 977-8700
Entity
Organization
Contact information
Practice address
12512 BRUCE B DOWNS BLVD, TAMPA, FL 33612-9209
(813) 977-8700
Mailing address
12512 BRUCE B DOWNS BLVD, TAMPA, FL 33612-9209
(813) 977-8700
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
SW7140
FL
Other
Enumeration date
05/11/2011
Last updated
05/11/2011
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