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General NPI Number Information
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NPI Number | 1104398122
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Entity Type | Organization
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Legal Business Name | THE DISCOVERY TREE THERAPIES, LLC
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Dates
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Enumeration Date | 01/02/2019
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 124 E MIRACLE STRIP PKWY STE 502
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City | MARY ESTHER
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State | FL
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Zip | 32569-1991
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Country | US
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Telephone | 350-368-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 124 E MIRACLE STRIP PKWY STE 502
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City | MARY ESTHER
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State | FL
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Zip | 32569-1991
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Country | US
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Telephone | 350-368-9373
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MELODY RAY
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Credential | BCBA, LMHC, NCC
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Telephone | 850-368-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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