MEDICARE: TDS THERAPY 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1245954213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TDS THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 778
Second Line	:
City	:	DOWNINGTOWN
State	:	PA
Zip	:	19335-0778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 E LANCASTER AVE
Second Line	:
City	:	DOWNINGTOWN
State	:	PA
Zip	:	19335-2974
Country	:	US
Telephone Number	:	610-947-4211
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	TODD DAVID SHIRLEY
Credential	:	LPC
Telephone Number	:	717-645-4478

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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