Provider Demographics
NPI:1972969418
Name:YOURTHERAPISTOFFICE, LLC
Entity Type:Organization
Organization Name:YOURTHERAPISTOFFICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:678-489-7384
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-0312
Mailing Address - Country:US
Mailing Address - Phone:678-489-7384
Mailing Address - Fax:866-311-8215
Practice Address - Street 1:90 COMMERCE DR
Practice Address - Street 2:STE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7519
Practice Address - Country:US
Practice Address - Phone:678-489-7384
Practice Address - Fax:866-311-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01277101YA0400X
GA001277101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty