Provider Demographics
NPI:1144690199
Name:A CAUSE FOR SUCCESS
Entity type:Organization
Organization Name:A CAUSE FOR SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, CSAT
Authorized Official - Phone:407-506-7097
Mailing Address - Street 1:3130 SEASONS WAY UNIT 407
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2304
Mailing Address - Country:US
Mailing Address - Phone:407-506-7097
Mailing Address - Fax:
Practice Address - Street 1:9180 ESTERO PARK COMMONS BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3218
Practice Address - Country:US
Practice Address - Phone:407-506-7097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA6OtherPSYCHOTHERAPY