Provider Demographics
NPI:1962758185
Name:DERVIL, YOLLE-GUIDA (LMFT)
Entity type:Individual
Prefix:
First Name:YOLLE-GUIDA
Middle Name:
Last Name:DERVIL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3328
Mailing Address - Country:US
Mailing Address - Phone:954-682-7903
Mailing Address - Fax:786-497-3863
Practice Address - Street 1:3900 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 232
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33309-3328
Practice Address - Country:US
Practice Address - Phone:954-682-7903
Practice Address - Fax:786-497-3863
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist