Provider Demographics
NPI:1740575208
Name:MELLOUL-BICKLER, AURELIA (PHD, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AURELIA
Middle Name:
Last Name:MELLOUL-BICKLER
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE #216
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1813
Mailing Address - Country:US
Mailing Address - Phone:954-315-1795
Mailing Address - Fax:954-315-1793
Practice Address - Street 1:2881 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE #220
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1813
Practice Address - Country:US
Practice Address - Phone:305-778-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist