| E5 Therapy Inc. | |
|
410 S Ware Blvd Ste 844 Tampa FL 33619-4469 | |
| (813) 362-6788 | |
| (813) 803-7348 |
| Full Name | E5 Therapy Inc. |
|---|---|
| Speciality | Counselor |
| Location | 410 S Ware Blvd Ste 844, Tampa, Florida |
| Authorized Official Name and Position | Matthew Eilers Decker (EXECUTIVE DIRECTOR/BOARD PRESIDENT) |
| Authorized Official Contact | 6023633156 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| E5 Therapy Inc. 333 Sunset Ave Ste 200 Suisun City CA 94585-2003 Ph: (707) 225-7899 | E5 Therapy Inc. 410 S Ware Blvd Ste 844 Tampa FL 33619-4469 Ph: (813) 362-6788 |
| NPI Number | 1083390124 |
|---|---|
| Provider Enumeration Date | 06/23/2023 |
| Last Update Date | 02/09/2024 |
| Certification Date | 02/09/2024 |
| Medicare PECOS PAC ID | 8527478627 |
|---|---|
| Medicare Enrollment ID | O20240328000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083390124 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kimberly Beasley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558945394 PECOS PAC ID: 0749627578 Enrollment ID: I20240328000612 |
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