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General NPI Number Information
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NPI Number | 1750175584
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Entity Type | Organization
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Legal Business Name | WANDERING TIDES THERAPY LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 771 NARRAGANSETT TRL STE 5
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City | BUXTON
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State | ME
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Zip | 04093-6602
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Country | US
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Telephone | 207-331-4723
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 259
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City | BUXTON
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State | ME
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Zip | 04093-0259
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND THERAPIST
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Name | KAYLEE ROBINSON
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Credential | LMFT-C
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Telephone | 402-560-8683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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