Provider Demographics
NPI:1275011231
Name:WHOLE FAMILY THERAPY, LLC.
Entity Type:Organization
Organization Name:WHOLE FAMILY THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-549-1521
Mailing Address - Street 1:6309 ROSEFINCH CT UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5162
Mailing Address - Country:US
Mailing Address - Phone:941-549-1521
Mailing Address - Fax:
Practice Address - Street 1:8636 E STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-3785
Practice Address - Country:US
Practice Address - Phone:941-549-1521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13958261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)