Provider Demographics
NPI:1255708608
Name:KILLMEYER, MARY (DMFT, LMFT)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:KILLMEYER
Suffix:
Gender:F
Credentials:DMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 NW 100TH WAY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6516
Mailing Address - Country:US
Mailing Address - Phone:954-609-8175
Mailing Address - Fax:
Practice Address - Street 1:1830 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5202
Practice Address - Country:US
Practice Address - Phone:954-609-8175
Practice Address - Fax:954-337-3722
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2678106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist