1649842154 NPI number — ZEN THERAPY LLC

Table of content: (NPI 1649842154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649842154 NPI number — ZEN THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZEN THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649842154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 W STATE ROAD 434 STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32750-3817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-530-0543
Provider Business Mailing Address Fax Number:
407-403-5818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 NEIGHBORHOOD MARKET RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32825-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-530-0543
Provider Business Practice Location Address Fax Number:
407-403-5818
Provider Enumeration Date:
07/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
DE LA TORRE
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
407-530-0543

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com