MEDICARE: THERAPY CAFE 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	:	1255119640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY CAFE LLC

Provider Business Mailing Address
First Line	:	35 DUKE ST UNIT 763
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-7528
Country	:	US
Telephone Number	:	443-295-8955
Fax Number	:	888-883-1589

Provider Business Practice Location Address
First Line	:	4522 W VILLAGE DR UNIT 1246
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-3429
Country	:	US
Telephone Number	:	443-295-8955
Fax Number	:	888-883-1589

Authorized Official
Title or Position	:	CFO
Name	:	MRS. ALLISON STENSON
Credential	:
Telephone Number	:	443-295-8955

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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Directions to “THERAPY CAFE LLC ” Practice Location

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