Healthcare Provider Details

I. General information

NPI: 1932918927
Provider Name (Legal Business Name): BETHLEHEM FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 MUD LAKE RD
PLANT CITY FL
33566-1009
US

IV. Provider business mailing address

5202 COTO PL
VALRICO FL
33596-8264
US

V. Phone/Fax

Practice location:
  • Phone: 813-752-4591
  • Fax:
Mailing address:
  • Phone: 313-806-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOMO ZM THOMAS II
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 313-806-2852