Provider Demographics
NPI:1245059740
Name:THE NOOK INCLUSIVE THERAPEUTIC CENTER LLC
Entity type:Organization
Organization Name:THE NOOK INCLUSIVE THERAPEUTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:352-871-5876
Mailing Address - Street 1:4723 NW 53RD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4804
Mailing Address - Country:US
Mailing Address - Phone:352-235-9006
Mailing Address - Fax:
Practice Address - Street 1:4723 NW 53RD AVE STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4804
Practice Address - Country:US
Practice Address - Phone:352-871-5876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty