Provider Demographics
NPI:1023384070
Name:FAMILY ASSESSMENT CLINIC
Entity Type:Organization
Organization Name:FAMILY ASSESSMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:COULBORN
Authorized Official - Last Name:FALLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-998-9700
Mailing Address - Street 1:555 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2584
Mailing Address - Country:US
Mailing Address - Phone:734-998-9700
Mailing Address - Fax:734-998-9710
Practice Address - Street 1:555 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2584
Practice Address - Country:US
Practice Address - Phone:734-998-9700
Practice Address - Fax:734-998-9710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty