Provider Demographics
NPI:1235578808
Name:FORT LAUDERDALE COUPLES, FAMILY AND INDIVIDUAL THERAPY, LLC
Entity Type:Organization
Organization Name:FORT LAUDERDALE COUPLES, FAMILY AND INDIVIDUAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LHMC
Authorized Official - Phone:954-789-9061
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:954-789-9061
Mailing Address - Fax:
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 221
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-789-9061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty