Provider Demographics
NPI:1205448370
Name:TEEN THERAPY SERVICES LLC
Entity type:Organization
Organization Name:TEEN THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-763-7266
Mailing Address - Street 1:3007 CARRINGTON POINTE RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5693
Mailing Address - Country:US
Mailing Address - Phone:479-763-7266
Mailing Address - Fax:866-474-4041
Practice Address - Street 1:5004 S U ST STE 202
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3600
Practice Address - Country:US
Practice Address - Phone:479-763-7266
Practice Address - Fax:866-474-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty