Provider Demographics
NPI:1285313080
Name:TREE OF LIFE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:TREE OF LIFE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAVERYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-354-0384
Mailing Address - Street 1:6313 FUR SEAL CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4318
Mailing Address - Country:US
Mailing Address - Phone:914-354-0384
Mailing Address - Fax:
Practice Address - Street 1:6313 FUR SEAL CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4318
Practice Address - Country:US
Practice Address - Phone:914-354-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty