MEDICARE: FAMILY PRACTICE & COUNSELING SERVICES NETWORK

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1285628826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE & COUNSELING SERVICES NETWORK

Provider Business Mailing Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:	BOX 110, SUITE 118, BLDG. D
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	267-597-3600
Fax Number	:	267-597-3622

Provider Business Practice Location Address
First Line	:	6120 WOODLAND AVE
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-3224
Country	:	US
Telephone Number	:	215-727-4721
Fax Number	:	215-726-4507

Authorized Official
Title or Position	:	CEO
Name	:	EMILY NICHOLS
Credential	:
Telephone Number	:	267-597-3604

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/01/2025

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