Provider Demographics
NPI:1528635851
Name:TELEWELLNESS THERAPY, LLC
Entity type:Organization
Organization Name:TELEWELLNESS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MYERS
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:205-370-5156
Mailing Address - Street 1:2408 SCEPTER LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2902
Mailing Address - Country:US
Mailing Address - Phone:205-370-5156
Mailing Address - Fax:
Practice Address - Street 1:2408 SCEPTER LN
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2902
Practice Address - Country:US
Practice Address - Phone:205-370-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty