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General NPI Number Information
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NPI Number | 1811852817
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Entity Type | Organization
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Legal Business Name | RED THERAPY GROUP
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 108 4TH AVE S STE 205
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City | FRANKLIN
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State | TN
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Zip | 37064-2676
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Country | US
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Telephone | 615-594-2830
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Fax |
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Provider Business Mailing Address
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Address Line | 109 LANES END DR
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City | FRANKLIN
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State | TN
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Zip | 37067-5101
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Country | US
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Telephone | 615-679-7105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY MARIE BOURQUE
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Credential | LMFT
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Telephone | 615-679-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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