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General NPI Number Information
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NPI Number | 1477249613
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Entity Type | Organization
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Legal Business Name | PSYCH THERAPY LLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 204 SANSBURY TRL
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City | WARNER ROBINS
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State | GA
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Zip | 31088-3142
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Country | US
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Telephone | 478-257-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 204 SANSBURY TRL
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City | WARNER ROBINS
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State | GA
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Zip | 31088-3142
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Country | US
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Telephone | 229-300-4524
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | PAMELA MARFELL
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Credential | LPC
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Telephone | 229-300-4524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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