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General NPI Number Information
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NPI Number | 1487128070
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Entity Type | Organization
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Legal Business Name | FAMILY AND CHILDREN'S PLACE
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 100 W COURT AVE STE 102
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3532
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Country | US
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Telephone | 502-893-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W COURT AVE STE 102
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3532
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Country | US
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Telephone | 502-893-3900
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Fax |
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Authorized Official
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Title or Position | FAMILY THERAPIST
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Name | BRISEYDA ALAS
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Credential | CSW, LSW
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Telephone | 502-893-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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