MEDICARE: ASSURE THERAPY CENTER 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	:	1285470443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSURE THERAPY CENTER LLC

Provider Business Mailing Address
First Line	:	101 PRATHER PARK DR STE D
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-3701
Country	:	US
Telephone Number	:	843-595-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 PRATHER PARK DR STE D
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-3701
Country	:	US
Telephone Number	:	843-595-6004
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAMRA MCDERMOTT
Credential	:	LPC
Telephone Number	:	843-595-6004

Provider Enumeration Date	:	07/06/2024
Last Update Date	:	07/06/2024

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