Healthcare Provider Details

I. General information

NPI: 1083363022
Provider Name (Legal Business Name): THERAPEUTIC WELL-BEING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 S LAKELAND DR STE 4
LAKELAND FL
33813-2578
US

IV. Provider business mailing address

7123 SUNSET GROVE CT
LAKELAND FL
33813-3661
US

V. Phone/Fax

Practice location:
  • Phone: 812-890-3327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY CAUDELL
Title or Position: OWNER
Credential: LMFT
Phone: 812-890-3327