Provider Demographics
NPI:1932807609
Name:LIFE TALK THERAPY LLC
Entity Type:Organization
Organization Name:LIFE TALK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:HUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-980-3163
Mailing Address - Street 1:825 JANET DALE LN
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2789
Mailing Address - Country:US
Mailing Address - Phone:410-980-3163
Mailing Address - Fax:410-969-2958
Practice Address - Street 1:825 JANET DALE LN
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2789
Practice Address - Country:US
Practice Address - Phone:410-980-3163
Practice Address - Fax:410-969-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD572015000Medicaid