Healthcare Provider Details

I. General information

NPI: 1740334358
Provider Name (Legal Business Name): FAMILY LIFE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GAULT AVE S
FORT PAYNE AL
35967-1824
US

IV. Provider business mailing address

300 GAULT AVE S
FORT PAYNE AL
35967-1824
US

V. Phone/Fax

Practice location:
  • Phone: 256-997-9356
  • Fax: 256-997-9314
Mailing address:
  • Phone: 256-997-9356
  • Fax: 256-997-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGUNE R CLECKLER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 256-997-9356