Provider Demographics
NPI:1316176381
Name:THERAPEUTIC INTERVENTION EARLY SERVICES, INC.
Entity type:Organization
Organization Name:THERAPEUTIC INTERVENTION EARLY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-204-0312
Mailing Address - Street 1:9470 LIVE OAK PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4769
Mailing Address - Country:US
Mailing Address - Phone:754-204-0312
Mailing Address - Fax:954-302-1830
Practice Address - Street 1:9470 LIVE OAK PL APT 405
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4747
Practice Address - Country:US
Practice Address - Phone:754-204-0312
Practice Address - Fax:954-302-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP3324251B00000X
FLSW9510251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761451900Medicaid