Provider Demographics
NPI:1114128675
Name:HEALTH FAMILY THERAPY, INC
Entity Type:Organization
Organization Name:HEALTH FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-871-3161
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE# 112
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-871-3161
Mailing Address - Fax:305-871-3162
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE# 112
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-871-3161
Practice Address - Fax:305-871-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation