Provider Demographics
NPI:1619623287
Name:MARRIAGE & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:MARRIAGE & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MUNDT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:561-503-3059
Mailing Address - Street 1:1175 NE 125TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5010
Mailing Address - Country:US
Mailing Address - Phone:561-503-3059
Mailing Address - Fax:561-634-2776
Practice Address - Street 1:1175 NE 125TH ST STE 320
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5010
Practice Address - Country:US
Practice Address - Phone:561-503-3059
Practice Address - Fax:561-634-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011164100Medicaid