Healthcare Provider Details

I. General information

NPI: 1275712911
Provider Name (Legal Business Name): ASSOCIATES IN FAMILY PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 PARKER COMMONS BLVD STE 101
FORT MYERS FL
33912-1812
US

IV. Provider business mailing address

13430 PARKER COMMONS BLVD STE 101
FORT MYERS FL
33912-1812
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-9955
  • Fax: 239-561-9779
Mailing address:
  • Phone: 239-561-9955
  • Fax: 239-561-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY MULHOLLAND
Title or Position: CO OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 239-561-9955