Provider Demographics
NPI:1225597891
Name:THERAPEUTICALLY BEAUTIFUL, LLC
Entity Type:Organization
Organization Name:THERAPEUTICALLY BEAUTIFUL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC,NCC
Authorized Official - Phone:954-361-5032
Mailing Address - Street 1:8400 N UNIVERSITY DR STE 111
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1700
Mailing Address - Country:US
Mailing Address - Phone:954-361-5032
Mailing Address - Fax:
Practice Address - Street 1:8400 N UNIVERSITY DR STE 111
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1700
Practice Address - Country:US
Practice Address - Phone:954-361-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty