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General NPI Number Information
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NPI Number | 1578088415
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPY PROVIDERS, PA
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Dates
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Enumeration Date | 08/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1830 N PINE ISLAND RD
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City | PLANTATION
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State | FL
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Zip | 33322-5202
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Country | US
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Telephone | 954-609-8175
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Fax | 954-337-3722
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Provider Business Mailing Address
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Address Line | 1830 N PINE ISLAND RD
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City | PLANTATION
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State | FL
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Zip | 33322-5202
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Country | US
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Telephone | 954-609-8175
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Fax | 954-337-3722
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY KILLMEYER
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Credential | DMFT, LMFT
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Telephone | 954-609-8175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MT2678
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License Number State | FL
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