Provider Demographics
NPI:1205657384
Name:EMERALD THERAPY CENTER, LLC
Entity type:Organization
Organization Name:EMERALD THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-205-8895
Mailing Address - Street 1:1640 MCCRACKEN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9562
Mailing Address - Country:US
Mailing Address - Phone:270-534-5128
Mailing Address - Fax:270-477-0007
Practice Address - Street 1:1640 MCCRACKEN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9562
Practice Address - Country:US
Practice Address - Phone:270-534-5128
Practice Address - Fax:270-477-0007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERALD THERAPY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty