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General NPI Number Information
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NPI Number | 1033614466
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Entity Type | Organization
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Legal Business Name | BEAUTIFULLY BROKEN THERAPY SERVICES LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 7027 OLD MADISON PIKE NW STE 108
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City | HUNTSVILLE
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State | AL
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Zip | 35806-2369
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Country | US
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Telephone | 256-631-6303
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Fax | 256-690-0992
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Provider Business Mailing Address
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Address Line | 7027 OLD MADISON PIKE NW STE 108
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City | HUNTSVILLE
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State | AL
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Zip | 35806-2369
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Country | US
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Telephone | 256-631-6303
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Fax | 256-690-0992
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | RHONDA MARIE STALB
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Credential | LMFT
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Telephone | 256-631-6303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | L478
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License Number State | AL
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