Healthcare Provider Details

I. General information

NPI: 1134875750
Provider Name (Legal Business Name): SPEAK EASY TELETHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 SHOAL CREEK DR
DEATSVILLE AL
36022-3486
US

IV. Provider business mailing address

691 SHOAL CREEK DR
DEATSVILLE AL
36022-3486
US

V. Phone/Fax

Practice location:
  • Phone: 706-315-7478
  • Fax: 334-625-1532
Mailing address:
  • Phone: 706-315-7478
  • Fax: 334-625-1532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTY SAVAGE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 706-315-7478