Provider Demographics
NPI:1659046852
Name:BESPOKE PSYCHOTHERAPY SERVICES, P.A.
Entity Type:Organization
Organization Name:BESPOKE PSYCHOTHERAPY SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATTLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-310-2110
Mailing Address - Street 1:TODD A. BATTLES, LMHC
Mailing Address - Street 2:17595 SOUTH TAMIAMI TRAIL, SUITE 210
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4884
Mailing Address - Country:US
Mailing Address - Phone:239-310-2110
Mailing Address - Fax:239-310-2111
Practice Address - Street 1:17595 S TAMIAMI TRL STE 210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4889
Practice Address - Country:US
Practice Address - Phone:239-310-2110
Practice Address - Fax:239-310-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health