Provider Demographics
NPI:1851845523
Name:AGAPE THERAPY INSTITUTE, CORP.
Entity Type:Organization
Organization Name:AGAPE THERAPY INSTITUTE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC-QS, LMFT-QS
Authorized Official - Phone:407-900-8633
Mailing Address - Street 1:510 CHRISTOR PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5332
Mailing Address - Country:US
Mailing Address - Phone:407-900-8633
Mailing Address - Fax:
Practice Address - Street 1:510 CHRISTOR PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5332
Practice Address - Country:US
Practice Address - Phone:407-900-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164898706OtherINDIVIDUAL NPI