Provider Demographics
NPI:1679331086
Name:SMALL TALK THERAPY LLC
Entity Type:Organization
Organization Name:SMALL TALK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPENCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MASW LISW
Authorized Official - Phone:937-244-1618
Mailing Address - Street 1:1045 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-4150
Mailing Address - Country:US
Mailing Address - Phone:937-244-1618
Mailing Address - Fax:
Practice Address - Street 1:1045 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4150
Practice Address - Country:US
Practice Address - Phone:937-244-1618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)