Healthcare Provider Details

I. General information

NPI: 1285487918
Provider Name (Legal Business Name): BARE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 WADING POINT BLVD
HUGER SC
29450-9813
US

IV. Provider business mailing address

1197 WADING POINT BLVD
HUGER SC
29450-9813
US

V. Phone/Fax

Practice location:
  • Phone: 717-875-4584
  • Fax:
Mailing address:
  • Phone: 717-875-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANGELA ROSE ENGLE
Title or Position: CEO
Credential: MA, LPC
Phone: 717-875-4584