=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316230378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC HEALTH ENDEAVORS INSTITUTE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2011
-----------------------------------------------------
Last Update Date | 05/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3565 E SUZIE LN
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34452-3250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-476-4364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 711
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34451-0711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARTHA MELINDA PHELPS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 352-476-4364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------