Provider Demographics
NPI:1306698311
Name:THERAPY WITHOUT WALLS RENEWED LLC
Entity type:Organization
Organization Name:THERAPY WITHOUT WALLS RENEWED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAJUANA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:RUSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-929-9019
Mailing Address - Street 1:PO BOX 608896
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-8896
Mailing Address - Country:US
Mailing Address - Phone:407-929-9019
Mailing Address - Fax:321-445-4710
Practice Address - Street 1:1303 N PINE HILLS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4816
Practice Address - Country:US
Practice Address - Phone:407-929-9019
Practice Address - Fax:321-445-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health