Healthcare Provider Details

I. General information

NPI: 1457733453
Provider Name (Legal Business Name): THERAPY INTERNATIONAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E CHERRY ST
KISSIMMEE FL
34744-4227
US

IV. Provider business mailing address

409 E CHERRY ST
KISSIMMEE FL
34744-4227
US

V. Phone/Fax

Practice location:
  • Phone: 407-931-3199
  • Fax: 407-931-1030
Mailing address:
  • Phone: 407-931-3199
  • Fax: 407-931-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6808
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 11783
License Number StateFL

VIII. Authorized Official

Name: MS. VALERIE GRAHAM CAMPBELL
Title or Position: CEO
Credential: LMHC
Phone: 407-931-3199