Provider Demographics
NPI:1326657305
Name:MYETHERAPIST LLC
Entity Type:Organization
Organization Name:MYETHERAPIST LLC
Other - Org Name:MYETHERAPIST LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDPAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-358-6744
Mailing Address - Street 1:301 KILLINGER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-6352
Mailing Address - Country:US
Mailing Address - Phone:813-358-7644
Mailing Address - Fax:
Practice Address - Street 1:301 KILLINGER AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-6352
Practice Address - Country:US
Practice Address - Phone:813-358-7644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty