Provider Demographics
NPI:1841478567
Name:MUNDT, ERIC THOMAS (LMFT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:THOMAS
Last Name:MUNDT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 JOG RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1247
Mailing Address - Country:US
Mailing Address - Phone:561-503-3059
Mailing Address - Fax:
Practice Address - Street 1:15200 JOG RD
Practice Address - Street 2:SUITE 303
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1247
Practice Address - Country:US
Practice Address - Phone:561-503-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist