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General NPI Number Information
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NPI Number | 1710069281
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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 | 10/20/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 5675 RUFFIN ROAD, SUITE 325
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City | SAN DIEGO
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State | CA
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Zip | 92123-1391
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Country | US
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Telephone | 858-467-9170
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Fax | 858-467-9183
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Provider Business Mailing Address
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Address Line | 5675 RUFFIN ROAD, SUITE 325
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City | SAN DIEGO
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State | CA
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Zip | 92123-1391
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Country | US
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Telephone | 858-467-9170
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Fax | 858-467-9183
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | MR. TODD HUNTER HUISKEN
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Credential | MFT
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Telephone | 858-467-9170
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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 | CA
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