Healthcare Provider Details

I. General information

NPI: 1538464359
Provider Name (Legal Business Name): THE FAMILY CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 LAWRENCE 2140
SARCOXIE MO
64862-8249
US

IV. Provider business mailing address

2295 LAWRENCE 2140
SARCOXIE MO
64862-8249
US

V. Phone/Fax

Practice location:
  • Phone: 417-310-3527
  • Fax: 866-826-4066
Mailing address:
  • Phone: 417-310-3527
  • Fax: 866-826-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. CARLA JANE HIEBSCH
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 417-310-3527