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General NPI Number Information
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NPI Number | 1316578719
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Entity Type | Organization
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Legal Business Name | FRONTLINE THERAPY LLC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 715 AVENUE D
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City | OPELIKA
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State | AL
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Zip | 36801-4961
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Country | US
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Telephone | 343-363-2178
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Fax |
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Provider Business Mailing Address
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Address Line | 930 W RICHLAND CIR
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City | AUBURN
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State | AL
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Zip | 36832-5430
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Country | US
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Telephone | 925-765-8345
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS KYLIE HATHAWAY
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Credential | LMFT
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Telephone | 343-363-2178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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