Provider Demographics
NPI:1316692262
Name:INFINITY THERAPY LLC
Entity type:Organization
Organization Name:INFINITY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:REVEL
Authorized Official - Middle Name:LERAE
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:218-766-6165
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:WAUBUN
Mailing Address - State:MN
Mailing Address - Zip Code:56589-0025
Mailing Address - Country:US
Mailing Address - Phone:218-325-0254
Mailing Address - Fax:218-983-3012
Practice Address - Street 1:1111 1ST ST
Practice Address - Street 2:
Practice Address - City:WAUBUN
Practice Address - State:MN
Practice Address - Zip Code:56589-4047
Practice Address - Country:US
Practice Address - Phone:218-325-0254
Practice Address - Fax:218-983-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health