Provider Demographics
NPI:1376967877
Name:MBS COUNSELING & FAMILY CENTER, LLC
Entity Type:Organization
Organization Name:MBS COUNSELING & FAMILY CENTER, LLC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FIELDS ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-547-3479
Mailing Address - Street 1:13022 NW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3107
Mailing Address - Country:US
Mailing Address - Phone:954-547-3479
Mailing Address - Fax:954-416-7846
Practice Address - Street 1:11820 MIRAMAR PKWY STE 224
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5818
Practice Address - Country:US
Practice Address - Phone:954-547-3479
Practice Address - Fax:954-416-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104197900Medicaid
FL1376967877Medicaid