Provider Demographics
NPI:1558994517
Name:OPEN HEARTS THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:OPEN HEARTS THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAGAIL
Authorized Official - Middle Name:JEANEAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:301-637-2792
Mailing Address - Street 1:17604 PHELPS HILL LN
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1358
Mailing Address - Country:US
Mailing Address - Phone:913-963-7133
Mailing Address - Fax:844-375-0213
Practice Address - Street 1:15717 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-6650
Practice Address - Country:US
Practice Address - Phone:301-637-2792
Practice Address - Fax:844-375-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health