Provider Demographics
NPI:1861718405
Name:THE MENDING GROUP
Entity type:Organization
Organization Name:THE MENDING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SUPER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-770-1201
Mailing Address - Street 1:PO BOX 141502
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-1502
Mailing Address - Country:US
Mailing Address - Phone:407-770-1200
Mailing Address - Fax:407-898-0858
Practice Address - Street 1:938 LAKE BALDWIN LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6651
Practice Address - Country:US
Practice Address - Phone:407-770-1200
Practice Address - Fax:407-898-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty