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General NPI Number Information
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NPI Number | 1134335458
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Entity Type | Organization
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Legal Business Name | FAMILY LIFE TODAY, INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 BELCHER RD S SUITE 7
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City | LARGO
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State | FL
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Zip | 33771-3321
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Country | US
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Telephone | 727-532-8220
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Fax | 727-524-8608
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Provider Business Mailing Address
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Address Line | 1000 BELCHER RD S SUITE 7
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City | LARGO
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State | FL
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Zip | 33771-3321
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Country | US
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Telephone | 727-532-8220
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Fax | 727-524-8608
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. JOAN MARILYN VAN WINGERDEN
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Credential | LCSW
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Telephone | 727-532-8220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW0003338
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License Number State | FL
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