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General NPI Number Information
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NPI Number | 1003643727
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Entity Type | Organization
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Legal Business Name | MARRIAGE & FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1725 W DR MARTIN LUTHER KING JR BLVD STE 105
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City | TAMPA
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State | FL
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Zip | 33607-6507
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Country | US
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Telephone | 561-774-8225
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Fax | 561-634-2776
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Provider Business Mailing Address
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Address Line | 15204 S JOG RD STE 303
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2171
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Country | US
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Telephone | 561-774-8225
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Fax | 561-634-2776
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Authorized Official
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Title or Position | CEO, CLINICAL DIRECTOR
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Name | ERIC THOMAS MUNDT
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Credential | LMFT
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Telephone | 561-503-3059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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