Provider Demographics
NPI:1225868995
Name:SPEAK:SUPPORTING PEOPLE EMOTIONALLY AND KINESTHETICALLY LLC
Entity type:Organization
Organization Name:SPEAK:SUPPORTING PEOPLE EMOTIONALLY AND KINESTHETICALLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIA
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,R-DMT
Authorized Official - Phone:773-930-7998
Mailing Address - Street 1:5953 SHADY LANE CIR
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-3243
Mailing Address - Country:US
Mailing Address - Phone:773-930-7998
Mailing Address - Fax:
Practice Address - Street 1:5953 SHADY LANE CIR
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-3243
Practice Address - Country:US
Practice Address - Phone:773-930-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty