Provider Demographics
NPI:1417387796
Name:ITHERAPYRX
Entity Type:Organization
Organization Name:ITHERAPYRX
Other - Org Name:ITHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PSYCHOLOGICAL ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:PULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:828-964-8790
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:ROARING GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28668-0056
Mailing Address - Country:US
Mailing Address - Phone:828-964-8790
Mailing Address - Fax:
Practice Address - Street 1:115 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9299
Practice Address - Country:US
Practice Address - Phone:828-964-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3453103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710167051OtherINDIVIDUAL NPI