Provider Demographics
NPI:1811685530
Name:THERAPY SHOP, LLC
Entity type:Organization
Organization Name:THERAPY SHOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-808-1320
Mailing Address - Street 1:11 COBLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1027
Mailing Address - Country:US
Mailing Address - Phone:781-808-1320
Mailing Address - Fax:
Practice Address - Street 1:11 COBLEIGH DR
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1027
Practice Address - Country:US
Practice Address - Phone:781-808-1320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty