Provider Demographics
NPI:1306654793
Name:ATHA THERAPY LLC
Entity type:Organization
Organization Name:ATHA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:615-482-0890
Mailing Address - Street 1:1222 16TH AVE S STE 24
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2926
Mailing Address - Country:US
Mailing Address - Phone:615-807-0818
Mailing Address - Fax:615-334-0433
Practice Address - Street 1:1222 16TH AVE S STE 24
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2926
Practice Address - Country:US
Practice Address - Phone:615-807-0818
Practice Address - Fax:615-334-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health