Provider Demographics
NPI:1477214625
Name:TIMELESS GUIDANCE FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:TIMELESS GUIDANCE FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAAC MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-206-5837
Mailing Address - Street 1:48 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6553
Mailing Address - Country:US
Mailing Address - Phone:203-206-5837
Mailing Address - Fax:
Practice Address - Street 1:48 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6553
Practice Address - Country:US
Practice Address - Phone:203-206-5837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty