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General NPI Number Information
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NPI Number | 1558970491
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Entity Type | Organization
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Legal Business Name | INSIGHTFUL THERAPEUTIC SOLUTIONS LLC
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 4770 S RIDGEWOOD AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-4544
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Country | US
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Telephone | 386-259-8071
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Fax | 386-204-8712
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Provider Business Mailing Address
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Address Line | 4770 S RIDGEWOOD AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-4544
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Country | US
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Telephone | 386-259-8071
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Fax | 386-204-8712
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. LIANA NOELLE MENENDEZ
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Credential | LCSW, RPT
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Telephone | 386-259-8071
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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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