Provider Demographics
NPI:1528940970
Name:UNTETHERED THERAPY SERVICES
Entity type:Organization
Organization Name:UNTETHERED THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FAIMMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MENYONGAI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:872-216-5273
Mailing Address - Street 1:10769 BROADWAY
Mailing Address - Street 2:PMB 208
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10769 BROADWAY
Practice Address - Street 2:PMB 208
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7316
Practice Address - Country:US
Practice Address - Phone:872-216-5273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)