Provider Demographics
NPI:1225435084
Name:TARGET THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:TARGET THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:III
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-218-3286
Mailing Address - Street 1:1903 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1380
Mailing Address - Country:US
Mailing Address - Phone:239-218-3286
Mailing Address - Fax:
Practice Address - Street 1:1903 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1380
Practice Address - Country:US
Practice Address - Phone:239-218-3286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW97681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431745099Medicaid