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General NPI Number Information
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NPI Number | 1053858316
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Entity Type | Organization
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Legal Business Name | THERAPY TREATMENT TEAM LLC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 12811 KENWOOD LN STE 202
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City | FORT MYERS
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State | FL
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Zip | 33907-5646
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Country | US
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Telephone | 239-537-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 12811 KENWOOD LN STE 202
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City | FORT MYERS
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State | FL
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Zip | 33907-5646
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Country | US
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Telephone | 239-537-9646
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Fax |
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Authorized Official
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Title or Position | CLINICAL OPERATIONS DIRECTOR
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Name | MRS. YAROSLABA GARCIA
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Credential | LMHC
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Telephone | 239-537-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11374
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License Number State | FL
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