Provider Demographics
NPI:1134833718
Name:AP THERAPEUTIC PRACTICE
Entity type:Organization
Organization Name:AP THERAPEUTIC PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-207-0774
Mailing Address - Street 1:16 KAS VILLA ACRES
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-9107
Mailing Address - Country:US
Mailing Address - Phone:601-207-0774
Mailing Address - Fax:
Practice Address - Street 1:16 KAS VILLA ACRES
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-9107
Practice Address - Country:US
Practice Address - Phone:601-207-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty