Provider Demographics
NPI:1285146613
Name:UNIVERSAL THERAPEUTIC SERVICES, LLC.
Entity type:Organization
Organization Name:UNIVERSAL THERAPEUTIC SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFNEY
Authorized Official - Middle Name:DAVIDSON
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW
Authorized Official - Phone:864-540-1209
Mailing Address - Street 1:PO BOX 8303
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8303
Mailing Address - Country:US
Mailing Address - Phone:864-380-5587
Mailing Address - Fax:864-484-8688
Practice Address - Street 1:103 LYDIA ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1240
Practice Address - Country:US
Practice Address - Phone:864-380-5587
Practice Address - Fax:864-484-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8170Medicaid