Provider Demographics
NPI:1033614466
Name:BEAUTIFULLY BROKEN THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:BEAUTIFULLY BROKEN THERAPY SERVICES LLC
Other - Org Name:RHONDA MARIE STALB LMFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STALB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:256-631-6303
Mailing Address - Street 1:7027 OLD MADISON PIKE NW STE 108
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2369
Mailing Address - Country:US
Mailing Address - Phone:256-631-6303
Mailing Address - Fax:256-690-0992
Practice Address - Street 1:7027 OLD MADISON PIKE NW STE 108
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2369
Practice Address - Country:US
Practice Address - Phone:256-631-6303
Practice Address - Fax:256-690-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL478106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty