Provider Demographics
NPI:1346606399
Name:EVAN A MEHLMAN, PA
Entity Type:Organization
Organization Name:EVAN A MEHLMAN, PA
Other - Org Name:WESTON FAMILY PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:MEHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-384-1117
Mailing Address - Street 1:2883 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3662
Mailing Address - Country:US
Mailing Address - Phone:954-384-1117
Mailing Address - Fax:954-384-1163
Practice Address - Street 1:2883 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3662
Practice Address - Country:US
Practice Address - Phone:954-384-1117
Practice Address - Fax:954-384-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty