=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679082408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE FEDERATION OF FAMILIES FOR CHILDREN'S MENTAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7475 W 5TH AVE STE 307
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-1675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-831-1199
-----------------------------------------------------
Fax | 303-662-9005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7475 W 5TH AVE STE 307
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-1675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-831-1199
-----------------------------------------------------
Fax | 303-662-9005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | IAN C ANDERSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-831-1199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------