Healthcare Provider Details

I. General information

NPI: 1356335129
Provider Name (Legal Business Name): FAMILY PRACTICE & COUNSELING SERVICES NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N 11TH ST
PHILADELPHIA PA
19123-1957
US

IV. Provider business mailing address

4700 WISSAHICKON AVE
PHILADELPHIA PA
19144-4248
US

V. Phone/Fax

Practice location:
  • Phone: 215-769-1100
  • Fax: 215-769-1117
Mailing address:
  • Phone: 215-438-4779
  • Fax: 215-298-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY NICHOLS
Title or Position: CEO
Credential:
Phone: 267-597-3604