| Bespoke Psychotherapy Services, P.a. | |
|
17595 S Tamiami Trl Ste 210 Fort Myers FL 33908-4889 | |
| (239) 310-2110 | |
| (239) 310-2111 |
| Full Name | Bespoke Psychotherapy Services, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 17595 S Tamiami Trl Ste 210, Fort Myers, Florida |
| Authorized Official Name and Position | Todd A. Battles (OWNER) |
| Authorized Official Contact | 2393102110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bespoke Psychotherapy Services, P.a. Todd A. Battles, Lmhc 17595 South Tamiami Trail, Suite 210 Fort Myers FL 33908-4884 Ph: (239) 310-2110 | Bespoke Psychotherapy Services, P.a. 17595 S Tamiami Trl Ste 210 Fort Myers FL 33908-4889 Ph: (239) 310-2110 |
| NPI Number | 1659046852 |
|---|---|
| Provider Enumeration Date | 08/10/2021 |
| Last Update Date | 12/09/2022 |
| Certification Date | 12/09/2022 |
| Medicare PECOS PAC ID | 0143678102 |
|---|---|
| Medicare Enrollment ID | O20231130003927 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659046852 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Todd Battles |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285243816 PECOS PAC ID: 1052769015 Enrollment ID: I20231130003947 |
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