Provider Demographics
NPI:1861153926
Name:NAUTICAL BREEZE THERAPY, LLC
Entity type:Organization
Organization Name:NAUTICAL BREEZE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:301-331-1664
Mailing Address - Street 1:29626 OLD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7929
Mailing Address - Country:US
Mailing Address - Phone:301-331-1664
Mailing Address - Fax:
Practice Address - Street 1:29626 OLD CREEK LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7929
Practice Address - Country:US
Practice Address - Phone:301-331-1664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-31
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty