Provider Demographics
NPI:1558982264
Name:TELETHERAPY SOLUTIONS LLC
Entity Type:Organization
Organization Name:TELETHERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BRUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-379-2807
Mailing Address - Street 1:9887 4TH ST N STE 319
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-8445
Mailing Address - Country:US
Mailing Address - Phone:727-379-2807
Mailing Address - Fax:
Practice Address - Street 1:9887 4TH ST N STE 319
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-8445
Practice Address - Country:US
Practice Address - Phone:727-379-2807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty