Provider Demographics
NPI:1649842154
Name:ZEN THERAPY LLC
Entity type:Organization
Organization Name:ZEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-530-0543
Mailing Address - Street 1:1400 W STATE ROAD 434 STE 1000
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3817
Mailing Address - Country:US
Mailing Address - Phone:407-530-0543
Mailing Address - Fax:407-403-5818
Practice Address - Street 1:222 NEIGHBORHOOD MARKET RD STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3525
Practice Address - Country:US
Practice Address - Phone:407-530-0543
Practice Address - Fax:407-403-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000000000Medicaid