Provider Demographics
NPI:1518344332
Name:MR. ED'S FAMILY & EDUCATION INTERVENTION SERVICES, INC.
Entity Type:Organization
Organization Name:MR. ED'S FAMILY & EDUCATION INTERVENTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LICENSED MENTAL HEALTH CO
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-899-2161
Mailing Address - Street 1:4733 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2083
Mailing Address - Country:US
Mailing Address - Phone:863-899-2162
Mailing Address - Fax:850-270-6733
Practice Address - Street 1:231 N TENNESSEE AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4970
Practice Address - Country:US
Practice Address - Phone:863-899-2162
Practice Address - Fax:850-270-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13244251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health