Healthcare Provider Details

I. General information

NPI: 1982975355
Provider Name (Legal Business Name): THERAPY WITHOUT WALLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S EUSTIS ST STE E
EUSTIS FL
32726-4886
US

IV. Provider business mailing address

PO BOX 608896
ORLANDO FL
32860-8896
US

V. Phone/Fax

Practice location:
  • Phone: 352-729-1860
  • Fax: 321-396-7574
Mailing address:
  • Phone: 352-729-1860
  • Fax: 321-396-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAJUANA DENISE RUSHIN
Title or Position: CLINICAL DIRECTOR
Credential: M.A., LMHC
Phone: 407-308-2436