MEDICARE: THERAPY MOMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1245821529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY MOMS

Provider Business Mailing Address
First Line	:	5945 NE 57TH LOOP
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-1203
Country	:	US
Telephone Number	:	352-816-5336
Fax Number	:

Provider Business Practice Location Address
First Line	:	5945 NE 57TH LOOP
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-1203
Country	:	US
Telephone Number	:	352-816-5336
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. MONA TERRY
Credential	:
Telephone Number	:	352-816-5336

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	01/29/2021

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Directions to “THERAPY MOMS ” Practice Location

Language	Start Address	Practice Location

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