Provider Demographics
NPI:1033381892
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICE MARYLAND AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:301-694-5896
Mailing Address - Street 1:172 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4404
Mailing Address - Country:US
Mailing Address - Phone:301-694-5896
Mailing Address - Fax:301-662-8737
Practice Address - Street 1:172 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4404
Practice Address - Country:US
Practice Address - Phone:301-694-5896
Practice Address - Fax:301-662-8737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00319261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)