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General NPI Number Information
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NPI Number | 1215590369
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Entity Type | Organization
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Legal Business Name | A FULFILLED LIFE INTERNATIONAL
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 3150 CARDINAL DR
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City | VERO BEACH
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State | FL
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Zip | 32963-1931
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Country | US
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Telephone | 772-985-4941
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2622
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City | VERO BEACH
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State | FL
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Zip | 32961-2622
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Country | US
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Telephone | 772-985-4941
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. FAMOUS ERWN
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Credential | LMHC
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Telephone | 772-985-4941
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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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