Provider Demographics
NPI:1851046239
Name:WHOLEHEARTED THERAPY LLC
Entity Type:Organization
Organization Name:WHOLEHEARTED THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-638-5847
Mailing Address - Street 1:33904 CLARA DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-4553
Mailing Address - Country:US
Mailing Address - Phone:352-638-5847
Mailing Address - Fax:
Practice Address - Street 1:1 W PARK AVE UNIT B
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2900
Practice Address - Country:US
Practice Address - Phone:863-825-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLADC-011572-2015OtherCAP