Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1407418205 |
---|---|
Provider Name | Dr. Brian James Letourneau |
First Address | Tampa, FL 33616-2924 |
Second Address | Tampa, FL 33606-3571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2019 |
Last Update Date | 01/07/2019 |