Provider Demographics
NPI:1689455453
Name:EVIDENCE-BASED PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:EVIDENCE-BASED PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:HONTORIA
Authorized Official - Last Name:TUERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-230-2233
Mailing Address - Street 1:1 BOARS HEAD LN STE B-6
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4681
Mailing Address - Country:US
Mailing Address - Phone:434-230-2233
Mailing Address - Fax:
Practice Address - Street 1:1 BOARS HEAD LN STE B-6
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4681
Practice Address - Country:US
Practice Address - Phone:434-230-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356645915OtherNPI