Provider Demographics
NPI:1003897489
Name:BROWARD MARRIAGE & FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:BROWARD MARRIAGE & FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMELIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL-KOLALLI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:954-394-0351
Mailing Address - Street 1:13469 NW 5TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6110
Mailing Address - Country:US
Mailing Address - Phone:954-394-0351
Mailing Address - Fax:954-746-5738
Practice Address - Street 1:4953 N UNIVERSITY DR
Practice Address - Street 2:SUITE #14-B- LOS MADEROS PLAZA
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-4506
Practice Address - Country:US
Practice Address - Phone:954-394-0351
Practice Address - Fax:954-746-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty