Provider Demographics
NPI:1932918927
Name:BETHLEHEM FAMILY SERVICES.
Entity type:Organization
Organization Name:BETHLEHEM FAMILY SERVICES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOMO
Authorized Official - Middle Name:ZM
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:II
Authorized Official - Credentials:LMFT
Authorized Official - Phone:313-806-2852
Mailing Address - Street 1:5202 COTO PL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8264
Mailing Address - Country:US
Mailing Address - Phone:313-806-2852
Mailing Address - Fax:
Practice Address - Street 1:2103 MUD LAKE RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-1009
Practice Address - Country:US
Practice Address - Phone:813-752-4591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1336278134Medicaid