Provider Demographics
NPI:1811641277
Name:INNOVATIVE THERAPISTS, LLC
Entity type:Organization
Organization Name:INNOVATIVE THERAPISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC-CS
Authorized Official - Phone:740-405-8053
Mailing Address - Street 1:309 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9414
Mailing Address - Country:US
Mailing Address - Phone:740-405-8053
Mailing Address - Fax:
Practice Address - Street 1:309 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783-9414
Practice Address - Country:US
Practice Address - Phone:740-405-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)