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General NPI Number Information
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NPI Number | 1659046852
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Entity Type | Organization
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Legal Business Name | BESPOKE PSYCHOTHERAPY SERVICES, P.A.
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 17595 S TAMIAMI TRL STE 210
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City | FORT MYERS
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State | FL
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Zip | 33908-4889
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Country | US
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Telephone | 239-310-2110
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Fax | 239-310-2111
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Provider Business Mailing Address
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Address Line | TODD A. BATTLES, LMHC 17595 SOUTH TAMIAMI TRAIL, SUITE 210
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City | FORT MYERS
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State | FL
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Zip | 33908-4884
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Country | US
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Telephone | 239-310-2110
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Fax | 239-310-2111
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Authorized Official
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Title or Position | OWNER
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Name | MR. TODD A. BATTLES
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Credential | LMHC
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Telephone | 239-310-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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