Provider Demographics
NPI:1063630788
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES AZ SNOWFLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-536-4117
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-0856
Mailing Address - Country:US
Mailing Address - Phone:928-536-4117
Mailing Address - Fax:928-536-7626
Practice Address - Street 1:641 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5595
Practice Address - Country:US
Practice Address - Phone:928-536-4117
Practice Address - Fax:928-536-4117
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-20
Last Update Date:2009-04-17
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-09-19
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
AZ860970901261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty