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General NPI Number Information
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NPI Number | 1003897489
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Entity Type | Organization
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Legal Business Name | BROWARD MARRIAGE & FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4953 N UNIVERSITY DR SUITE #14-B- LOS MADEROS PLAZA
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City | LAUDERHILL
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State | FL
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Zip | 33351-4506
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Country | US
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Telephone | 954-394-0351
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Fax | 954-746-5738
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Provider Business Mailing Address
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Address Line | 13469 NW 5TH CT
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City | PLANTATION
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State | FL
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Zip | 33325-6110
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Country | US
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Telephone | 954-394-0351
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Fax | 954-746-5738
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Authorized Official
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Title or Position | MARRIAGE & FAMILY THERAPIST/OWNER
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Name | MRS. KAMELIA A. EL-KOLALLI
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Credential | LMFT
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Telephone | 954-394-0351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1977
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License Number State | FL
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