Provider Demographics
NPI:1710713714
Name:MOVE MOUNTAINS THERAPY LLC
Entity type:Organization
Organization Name:MOVE MOUNTAINS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:TORRY
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:901-596-5919
Mailing Address - Street 1:3863 HIGHWAY 138 SE UNIT 62
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4143
Mailing Address - Country:US
Mailing Address - Phone:901-596-5919
Mailing Address - Fax:
Practice Address - Street 1:718 BASSWOOD AVE
Practice Address - Street 2:
Practice Address - City:MADONNA
Practice Address - State:GA
Practice Address - Zip Code:30252
Practice Address - Country:US
Practice Address - Phone:901-596-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1679253868OtherMENTAL HEALTH THERAPY COUNSELING