Healthcare Provider Details

I. General information

NPI: 1104593193
Provider Name (Legal Business Name): THERAPY EMPORIUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST
GREAT BARRINGTON MA
01230-1745
US

IV. Provider business mailing address

740 MAIN STREET SUITE 1
GREAT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-613-5909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER LYONS
Title or Position: CO-OWNER
Credential: PH.D.
Phone: 413-613-5909