Healthcare Provider Details

I. General information

NPI: 1366226235
Provider Name (Legal Business Name): THE THERAPY TREE FOR PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 BOWENS MILL RD SW
DOUGLAS GA
31533-3926
US

IV. Provider business mailing address

618 BOWENS MILL RD SW
DOUGLAS GA
31533-3926
US

V. Phone/Fax

Practice location:
  • Phone: 912-331-0846
  • Fax: 678-792-4894
Mailing address:
  • Phone: 912-331-0846
  • Fax: 678-792-4894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MISTY BROWN
Title or Position: CFO
Credential:
Phone: 912-331-0846