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General NPI Number Information
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NPI Number | 1407447600
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Entity Type | Organization
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Legal Business Name | EARTH HAVEN THERAPY INC.
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 11/25/2021
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Provider Practice Location Address
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Address Line | 8760 SW 21ST CT
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City | OCALA
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State | FL
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Zip | 34476-6732
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Country | US
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Telephone | 818-272-6442
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Fax | 714-333-4407
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Provider Business Mailing Address
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Address Line | 8760 SW 21ST CT
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City | OCALA
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State | FL
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Zip | 34476-6732
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Country | US
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Telephone | 818-272-6442
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Fax | 714-333-4407
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Authorized Official
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Title or Position | LMFT
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Name | LINDA MONIQUE BERT
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Credential | MA, LMFT, CAAP
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Telephone | 818-272-6442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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