Provider Demographics
NPI:1982975355
Name:THERAPY WITHOUT WALLS, LLC
Entity Type:Organization
Organization Name:THERAPY WITHOUT WALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAJUANA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:RUSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:407-308-2436
Mailing Address - Street 1:PO BOX 608896
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-8896
Mailing Address - Country:US
Mailing Address - Phone:352-729-1860
Mailing Address - Fax:321-396-7574
Practice Address - Street 1:800 S EUSTIS ST STE E
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4886
Practice Address - Country:US
Practice Address - Phone:352-729-1860
Practice Address - Fax:321-396-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management