Provider Demographics
NPI:1598154262
Name:UNTETHERED THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:UNTETHERED THERAPY GROUP, LLC
Other - Org Name:UNTETHERED THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-216-8287
Mailing Address - Street 1:570 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3530
Mailing Address - Country:US
Mailing Address - Phone:304-216-8287
Mailing Address - Fax:
Practice Address - Street 1:570 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3530
Practice Address - Country:US
Practice Address - Phone:304-216-8287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC 007892101YP2500X
PAMF000693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty