Provider Demographics
NPI:1699412858
Name:T.E.A TIME THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:T.E.A TIME THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSEY-MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-217-5462
Mailing Address - Street 1:5710 NE MIAMI CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2063
Mailing Address - Country:US
Mailing Address - Phone:786-217-5462
Mailing Address - Fax:
Practice Address - Street 1:5710 NE MIAMI CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2063
Practice Address - Country:US
Practice Address - Phone:786-217-5462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty