Provider Demographics
NPI:1285369439
Name:MANSFIELD FAMILY THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:MANSFIELD FAMILY THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP/L
Authorized Official - Phone:630-301-0549
Mailing Address - Street 1:1395 FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3766
Mailing Address - Country:US
Mailing Address - Phone:630-301-0549
Mailing Address - Fax:817-549-5885
Practice Address - Street 1:1395 FAIRHAVEN DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3766
Practice Address - Country:US
Practice Address - Phone:630-301-0549
Practice Address - Fax:817-549-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech