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General NPI Number Information
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NPI Number | 1184174286
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Entity Type | Organization
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Legal Business Name | REAL THERAPY SOLUTIONS, INC
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 3028 CARING WAY UNIT 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-276-7889
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Fax | 941-249-5039
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Provider Business Mailing Address
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Address Line | 3028 CARING WAY UNIT 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-276-7889
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Fax | 941-249-5039
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Authorized Official
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Title or Position | CEO
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Name | MR. RANDALL CROUCH
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Credential | LMHC
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Telephone | 941-276-7889
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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 | MH10076
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License Number State | FL
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