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General NPI Number Information
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NPI Number | 1518185891
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Entity Type | Organization
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Legal Business Name | LDS FAMILY SERVICES
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 1425 N RABE AVE STE 101
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City | FRESNO
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State | CA
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Zip | 93727-2117
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Country | US
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Telephone | 559-255-1446
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Fax | 559-255-4876
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Provider Business Mailing Address
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Address Line | 1425 N RABE AVE STE 101
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City | FRESNO
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State | CA
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Zip | 93727-2117
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Country | US
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Telephone | 559-255-1446
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Fax | 559-255-4876
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | BRIAN R ANDERSON
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Credential | LCSW
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Telephone | 559-255-1446
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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 | 107000144
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License Number State | CA
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