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General NPI Number Information
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NPI Number | 1003704081
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Entity Type | Organization
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Legal Business Name | LITTLE FERN THERAPY, PLLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1400 N WOOD RD STE 22
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City | MURPHYSBORO
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State | IL
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Zip | 62966-6290
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Country | US
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Telephone | 618-924-1623
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Fax |
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Provider Business Mailing Address
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Address Line | 627 S SURREY LN
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City | CARBONDALE
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State | IL
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Zip | 62901-2110
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Country | US
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Telephone | 618-924-1623
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | TALI KASSER
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Credential | PSYCHOLOGIST
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Telephone | 618-924-1623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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