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General NPI Number Information
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NPI Number | 1720739550
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Entity Type | Organization
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Legal Business Name | FALLING UP THERAPY SERVICES
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 859 WILLARD ST STE 400
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City | QUINCY
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State | MA
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Zip | 02169-7469
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Country | US
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Telephone | 857-269-3752
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Fax |
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Provider Business Mailing Address
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Address Line | 859 WILLARD ST STE 400
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City | QUINCY
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State | MA
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Zip | 02169-7469
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Country | US
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Telephone | 857-269-3752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLAY YATES
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Credential | LMHC, MT-BC
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Telephone | 857-269-3752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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