Provider Demographics
NPI:1922862481
Name:FRONT LINE THERAPY, LLC
Entity Type:Organization
Organization Name:FRONT LINE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-868-4815
Mailing Address - Street 1:3737 WOODLAND AVE STE 620
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1909
Mailing Address - Country:US
Mailing Address - Phone:515-868-4815
Mailing Address - Fax:
Practice Address - Street 1:3737 WOODLAND AVE STE 620
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1909
Practice Address - Country:US
Practice Address - Phone:515-868-4815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty