MEDICARE: MOVING INTO NEW DIMENSIONS THERAPEUTIC SERVICES LLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710870084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVING INTO NEW DIMENSIONS THERAPEUTIC SERVICES LLLC

Provider Business Mailing Address
First Line	:	405 SEAFOAM CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-1203
Country	:	US
Telephone Number	:	561-294-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 SEAFOAM CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-1203
Country	:	US
Telephone Number	:	561-294-5888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LATONYA DENISE SHAW
Credential	:	DHA, LMHC. EMDR
Telephone Number	:	561-294-5888

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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Directions to “MOVING INTO NEW DIMENSIONS THERAPEUTIC SERVICES LLLC ” Practice Location

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