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General NPI Number Information
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NPI Number | 1982975355
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Entity Type | Organization
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Legal Business Name | THERAPY WITHOUT WALLS, LLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 800 S EUSTIS ST STE E
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City | EUSTIS
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State | FL
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Zip | 32726-4886
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Country | US
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Telephone | 352-729-1860
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Fax | 321-396-7574
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Provider Business Mailing Address
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Address Line | PO BOX 608896
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City | ORLANDO
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State | FL
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Zip | 32860-8896
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Country | US
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Telephone | 352-729-1860
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Fax | 321-396-7574
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | TAJUANA DENISE RUSHIN
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Credential | M.A., LMHC
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Telephone | 407-308-2436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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