Organization · NPI-2

Exit 56 Therapy Group LLC

Social Worker, Clinical · Crestview, FL

NPI number1013733799

StatusActive

Last updated in NPPESNov 27, 2024

Details

NPI: 1013733799
Entity type: Organization (NPI-2)
Legal business name: Exit 56 Therapy Group LLC
Organization subpart: No
Enumeration date: Nov 27, 2024
Certification date: Nov 27, 2024
Last updated: Nov 27, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
1041C0700X	Social Worker, Clinical	–	–	Yes
101YM0800X	Counselor, Mental Health	–	–
103TC0700X	Psychologist, Clinical	–	–
103TS0200X	Psychologist, School	–	–
224Z00000X	Occupational Therapy Assistant	–	–
2251P0200X	Physical Therapist, Pediatrics	–	–
225XP0200X	Occupational Therapist, Pediatrics	–	–
235Z00000X	Speech-Language Pathologist,	–	–

Practice location

124 John King Rd
Crestview, FL 32539-8306

Phone 850-634-6020 · Fax 850-680-6289

Mailing address

124 John King Rd
Crestview, FL 32539-8306

Phone 850-634-6020 · Fax 850-680-6289

Authorized official

Gabrielle Griffith
President
8506346020

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