Provider Demographics
NPI:1912773359
Name:5A THERAPY LLC
Entity type:Organization
Organization Name:5A THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:786-495-6503
Mailing Address - Street 1:12401 NE 16TH AVE APT 425
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6003
Mailing Address - Country:US
Mailing Address - Phone:786-495-6503
Mailing Address - Fax:
Practice Address - Street 1:12401 NE 16TH AVE APT 425
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6003
Practice Address - Country:US
Practice Address - Phone:786-495-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)