Provider Demographics
NPI:1558036764
Name:TELETHERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:TELETHERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS MFT LADC
Authorized Official - Phone:860-385-1422
Mailing Address - Street 1:46 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1654
Mailing Address - Country:US
Mailing Address - Phone:860-385-1422
Mailing Address - Fax:877-346-8993
Practice Address - Street 1:46 BARBARA LN
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1654
Practice Address - Country:US
Practice Address - Phone:860-385-1422
Practice Address - Fax:877-346-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty