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General NPI Number Information
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NPI Number | 1811445935
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Entity Type | Organization
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Legal Business Name | A SIMPLE THERAPY LLC
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 53 EXCHANGE ST SUITE 202
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City | PORTLAND
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State | ME
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Zip | 04101-5034
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Country | US
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Telephone | 207-653-1496
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Fax | 207-842-9007
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Provider Business Mailing Address
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Address Line | 53 EXCHANGE ST SUITE 202
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City | PORTLAND
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State | ME
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Zip | 04101-5034
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Country | US
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Telephone | 207-653-1496
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Fax | 207-842-9007
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Authorized Official
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Title or Position | PRESIDENT
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Name | SINDEE J GOZANSKY
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Credential | LCPC
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Telephone | 207-653-1496
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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 | CC3809
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License Number State | ME
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