PHILIP J FAUERBACH, LMHC
Mental Health at Parsons Ave, Brandon, FL

License number
Florida MH3399
Category
Mental Health
Type
Mental Health
Owner
Name: MR. PHILIP J FAUERBACH LMHC
Title: PRESIDENT
Phone: (881) 365-1122
Address
Address 2
915 S Parsons Ave #C, Brandon, FL 33511
3812 Hanover Hill Dr, Valrico, FL 33596
National Provider ID: 1124491105
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PHILIP J. FAUERBACH, LMHC, PA

3812 Hanover Hl Dr, Valrico, FL 33596

Status:
Inactive
Industry:
Business Services at Non-Commercial Site, Specialty Outpatient Clinic
Doing business as:
Philip J Fauerbach Lmhc
Inactive reason:
Cancel Adm Diss/rev
Registration:
Jun 30, 2006
Inactive since:
Jan 16, 2009
State ID:
P06000088596
Business type:
Florida Profit Corporation
Secretarys:
Philip Fauerbach (Principal, President), 3812 Hanover Hl Dr, Valrico, FL 33596 (Physical),Barbara Fauerbach (Treasurer), 3812 Hanover Hl Dr, Valrico, FL 33596 (Physical),Stephani Fauerbach (Vice President), 3964 Pond Rdg Dr, Riverview, FL 33569 (Physical),...
Agent:
Fauerbach, Philip,3812 Hanover Hl Dr, Valrico, FL 33596 (Physical)
EIN:
20-5337863

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