Healthcare Provider Details

I. General information

NPI: 1467925420
Provider Name (Legal Business Name): THE FAMILY PLACE D/B/A TFP SERVICES THERAPEUTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NE 2ND ST.
ONTARIO OR
97914
US

IV. Provider business mailing address

P.O. BOX V, (ONTARIO) 390 NE 2ND ST.
ONTARIO OR
97914
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-1050
  • Fax: 541-889-6524
Mailing address:
  • Phone: 541-889-1050
  • Fax: 541-889-6524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. TESS D. SHELLENBARGER
Title or Position: EXEC DIRECTOR
Credential: LCPC(ID), LPC(OR)
Phone: 541-889-1050