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General NPI Number Information
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NPI Number | 1861718405
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Entity Type | Organization
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Legal Business Name | THE MENDING GROUP
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 938 LAKE BALDWIN LN
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City | ORLANDO
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State | FL
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Zip | 32814-6651
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Country | US
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Telephone | 407-770-1200
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Fax | 407-898-0858
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Provider Business Mailing Address
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Address Line | PO BOX 141502
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City | ORLANDO
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State | FL
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Zip | 32814-1502
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Country | US
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Telephone | 407-770-1200
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Fax | 407-898-0858
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN THOMAS SUPER
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Credential | MA
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Telephone | 407-770-1201
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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 |
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License Number State |
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