| Organization Name: | FORT LAUDERDALE COUPLES, FAMILY AND INDIVIDUAL THERAPY, LLC |
| NPI Number: | 1235578808 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS B NELSON (OWNER) |
| Mailing Address: | 1881 Ne 26th St Suite 221 Wilton Manors |
| State: | FL US |
| Postal Code: | 333051416 |
| Phone Number: | 9547899061 |
| Fax Number: | |
| NPI Enumeration Date: | 06/17/2013 |
| NPI Last Update Date: | 10/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH11689 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |