Provider Demographics
NPI:1245097716
Name:EP THERAPY, PLLC
Entity type:Organization
Organization Name:EP THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:973-563-0289
Mailing Address - Street 1:8726 MAPLEWOOD DR # 1
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1418
Mailing Address - Country:US
Mailing Address - Phone:973-563-0289
Mailing Address - Fax:
Practice Address - Street 1:8726 MAPLEWOOD DR # 1
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1418
Practice Address - Country:US
Practice Address - Phone:269-285-1087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty