Provider Demographics
NPI:1366108961
Name:THE MOBILE OFFICE THERAPIST LLC
Entity type:Organization
Organization Name:THE MOBILE OFFICE THERAPIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:LATREECE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYES-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-745-6724
Mailing Address - Street 1:107 CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3103
Mailing Address - Country:US
Mailing Address - Phone:800-745-6724
Mailing Address - Fax:
Practice Address - Street 1:107 CARMEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3103
Practice Address - Country:US
Practice Address - Phone:800-745-6724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty