MEDICARE: LDS FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1174634240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	517 W WALNUT ST
Second Line	:	SUITE 2
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-3632
Country	:	US
Telephone Number	:	816-461-5512
Fax Number	:	816-461-4907

Provider Business Practice Location Address
First Line	:	517 W WALNUT ST
Second Line	:	SUITE 2
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-3632
Country	:	US
Telephone Number	:	816-461-5512
Fax Number	:	816-461-4907

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	MR. PAUL R GALE
Credential	:	LCSW
Telephone Number	:	816-461-5512

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/06/2008

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Directions to “LDS FAMILY SERVICES ” Practice Location

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