=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851602023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY BEHAVIORAL RESOURCES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2010
-----------------------------------------------------
Last Update Date | 06/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 KENSINGTON SQ SUITE B
-----------------------------------------------------
City | NEW KENSINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-6443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-335-9733
-----------------------------------------------------
Fax | 724-335-9734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 KENSINGTON SQUARE SUITE B
-----------------------------------------------------
City | NEW KENSINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-335-9733
-----------------------------------------------------
Fax | 724-335-9734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OUTPATIENT THERAPIST
-----------------------------------------------------
Name | MR. GRANT J. KISSEL
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 724-335-9733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------