Healthcare Provider Details

I. General information

NPI: 1629892856
Provider Name (Legal Business Name): TLT GLOBAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BEACON ST
HAMDEN CT
06514
US

IV. Provider business mailing address

24 BEACON ST
HAMDEN CT
06514
US

V. Phone/Fax

Practice location:
  • Phone: 434-632-4840
  • Fax:
Mailing address:
  • Phone: 434-632-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HORACE FENTON SMITH III
Title or Position: OWNER / CEO
Credential:
Phone: 434-632-4840