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General NPI Number Information
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NPI Number | 1558036764
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Entity Type | Organization
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Legal Business Name | TELETHERAPY SERVICES PLLC
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 46 BARBARA LN
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City | PLANTSVILLE
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State | CT
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Zip | 06479-1654
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Country | US
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Telephone | 860-385-1422
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Fax | 877-346-8993
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Provider Business Mailing Address
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Address Line | 46 BARBARA LN
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City | PLANTSVILLE
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State | CT
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Zip | 06479-1654
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Country | US
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Telephone | 860-385-1422
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Fax | 877-346-8993
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KRISTEN S. BIRMINGHAM
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Credential | MS MFT LADC
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Telephone | 860-385-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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