=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194376590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TLS CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2019
-----------------------------------------------------
Last Update Date | 09/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13971 N. CLEVELAND AVENUE #9
-----------------------------------------------------
City | NORTH FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-997-7770
-----------------------------------------------------
Fax | 239-997-7776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13971 N. CLEVELAND AVENUE #9
-----------------------------------------------------
City | NORTH FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-997-7770
-----------------------------------------------------
Fax | 239-997-7776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | TANYA LANE SLATER
-----------------------------------------------------
Credential | MCAP, CMHP, ICRC-ADC
-----------------------------------------------------
Telephone | 239-997-7770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------