Provider Demographics
NPI:1689395600
Name:SOUTHWEST EMDR THERAPY LLC
Entity Type:Organization
Organization Name:SOUTHWEST EMDR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-220-8456
Mailing Address - Street 1:966 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2483
Mailing Address - Country:US
Mailing Address - Phone:276-207-8321
Mailing Address - Fax:888-548-4146
Practice Address - Street 1:966 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2483
Practice Address - Country:US
Practice Address - Phone:276-207-8321
Practice Address - Fax:888-548-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty