Provider Demographics
NPI:1316357726
Name:FRESH START THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:FRESH START THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-900-5164
Mailing Address - Street 1:650 N ALAFAYA TRL
Mailing Address - Street 2:STE 101 # 782409
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-7501
Mailing Address - Country:US
Mailing Address - Phone:407-900-5164
Mailing Address - Fax:
Practice Address - Street 1:1417 N SEMORAN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3555
Practice Address - Country:US
Practice Address - Phone:407-099-5164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11509101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHR640AOtherMEDICARE PTAN