Provider Demographics
NPI:1356654859
Name:MEMBERSHIP THERAPY CENTER, C.M.H.C., INC.
Entity Type:Organization
Organization Name:MEMBERSHIP THERAPY CENTER, C.M.H.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER /REGISTERED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORCAS
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS STUDENT
Authorized Official - Phone:786-413-8487
Mailing Address - Street 1:10680 SW 186TH ST STE 36
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6720
Mailing Address - Country:US
Mailing Address - Phone:305-969-9448
Mailing Address - Fax:305-969-9748
Practice Address - Street 1:10680 SW 186TH ST STE 36
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6720
Practice Address - Country:US
Practice Address - Phone:305-969-9448
Practice Address - Fax:305-969-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4025251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health