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General NPI Number Information
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NPI Number | 1801379805
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Entity Type | Organization
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Legal Business Name | THERAPETEE, PLC
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 672 SE MONTEREY RD
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City | STUART
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State | FL
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Zip | 34994-4410
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Country | US
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Telephone | 772-708-2830
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Fax | 772-237-3750
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Provider Business Mailing Address
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Address Line | 3768 NE MELBA DR
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City | JENSEN BEACH
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State | FL
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Zip | 34957-3867
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Country | US
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Telephone | 772-708-2830
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Fax | 772-237-3750
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | PETRINA MCGOWEN
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Credential | LMFT
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Telephone | 772-708-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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