Provider Demographics
NPI:1679307870
Name:MENTAL AND EMOTIONAL THERAPEUTICS, LLC
Entity type:Organization
Organization Name:MENTAL AND EMOTIONAL THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP, LCSW
Authorized Official - Phone:843-222-3019
Mailing Address - Street 1:3588 CROSSCREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7594
Mailing Address - Country:US
Mailing Address - Phone:843-222-3019
Mailing Address - Fax:
Practice Address - Street 1:3588 CROSSCREEK DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7594
Practice Address - Country:US
Practice Address - Phone:843-222-3019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health