Provider Demographics
NPI:1346982782
Name:FKL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:FKL ENTERPRISES, LLC
Other - Org Name:ELLIE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FILIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:COELHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-240-3461
Mailing Address - Street 1:8700 E VIA DE VENTURA STE 280
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4541
Mailing Address - Country:US
Mailing Address - Phone:480-210-7266
Mailing Address - Fax:
Practice Address - Street 1:8700 E VIA DE VENTURA STE 280
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4541
Practice Address - Country:US
Practice Address - Phone:480-210-7266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty