Healthcare Provider Details

I. General information

NPI: 1811852817
Provider Name (Legal Business Name): RED THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 4TH AVE S STE 205
FRANKLIN TN
37064-2676
US

IV. Provider business mailing address

109 LANES END DR
FRANKLIN TN
37067-5101
US

V. Phone/Fax

Practice location:
  • Phone: 615-594-2830
  • Fax:
Mailing address:
  • Phone: 615-679-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KELLY MARIE BOURQUE
Title or Position: OWNER
Credential: LMFT
Phone: 615-679-7105