Provider Demographics
NPI:1184366452
Name:FUNDAMENTAL THERAPY SOLUTIONS
Entity type:Organization
Organization Name:FUNDAMENTAL THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-505-6363
Mailing Address - Street 1:3250 SE 58TH AVENUE
Mailing Address - Street 2:UNIT 1 & 2
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480
Mailing Address - Country:US
Mailing Address - Phone:352-390-0092
Mailing Address - Fax:
Practice Address - Street 1:3250 SE 58TH AVENUE
Practice Address - Street 2:UNIT 1 & 2
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480
Practice Address - Country:US
Practice Address - Phone:352-390-0092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUNDAMENTAL THERAPY SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty