MEDICARE: EMERICK THERAPY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033807417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERICK THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	1850 LAKE PARK DR SE STE 216
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7642
Country	:	US
Telephone Number	:	770-810-5211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 LAKE PARK DR SE STE 216
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7642
Country	:	US
Telephone Number	:	770-810-5211
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	TORI EMERICK
Credential	:	LPC
Telephone Number	:	770-810-5211

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	05/10/2023

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