=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073972196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADULT THERAPY SOLUTIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2016
-----------------------------------------------------
Last Update Date | 02/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 DARCEE CT
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-7402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-858-4777
-----------------------------------------------------
Fax | 678-985-3953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65 DARCEE CT
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-7402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-858-4777
-----------------------------------------------------
Fax | 678-985-3953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BROOK TODD
-----------------------------------------------------
Credential | M.ED.
-----------------------------------------------------
Telephone | 678-858-4777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------