MEDICARE: ALONSO T MANNS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT1960	FL

General Provider Information

NPI Number	:	1245395938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALONSO T MANNS LMFT

Provider Business Mailing Address
First Line	:	PO BOX 5643
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33310-5643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 W OAKLAND PARK BLVD
Second Line	:	STE 118
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311
Country	:	US
Telephone Number	:	954-567-4175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2006
Last Update Date	:	07/08/2007

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