Healthcare Provider Details

I. General information

NPI: 1235378522
Provider Name (Legal Business Name): MTS THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S SHORE DR
JACKSONVILLE NC
28540-5647
US

IV. Provider business mailing address

303 S SHORE DR
JACKSONVILLE NC
28540-5647
US

V. Phone/Fax

Practice location:
  • Phone: 910-938-0670
  • Fax: 910-938-1229
Mailing address:
  • Phone: 910-938-0670
  • Fax: 910-938-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS TREVOUR SHEPARD
Title or Position: OWNER/OPERATOR
Credential: BA, QP
Phone: 910-376-2276