Provider Demographics
NPI:1215590369
Name:A FULFILLED LIFE INTERNATIONAL
Entity Type:Organization
Organization Name:A FULFILLED LIFE INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FAMOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-985-4941
Mailing Address - Street 1:PO BOX 2622
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-2622
Mailing Address - Country:US
Mailing Address - Phone:772-985-4941
Mailing Address - Fax:
Practice Address - Street 1:3150 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1931
Practice Address - Country:US
Practice Address - Phone:772-985-4941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty