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General NPI Number Information
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NPI Number | 1689725053
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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 | 01/14/2007
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 1309 FIELDSTONE DR
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City | BEDFORD
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State | TX
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Zip | 76022-6755
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Country | US
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Telephone | 817-691-5184
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 FIELDSTONE DR
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City | BEDFORD
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State | TX
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Zip | 76022-6755
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Country | US
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Telephone | 817-691-5184
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Fax |
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Authorized Official
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Title or Position | COUNSELING MANAGER
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Name | ERIC OAKES LARSON
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Credential | LCSW
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Telephone | 214-538-7847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | TX
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