=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346115458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE INTENTIONAL RELATIONSHIP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2025
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5820 CLARION ST STE 201
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040-0389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-370-7482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5820 CLARION ST STE 201
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040-0389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-370-7482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA BASSETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-940-3712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------