Provider Demographics
NPI:1144761883
Name:FRIENDS OF THE FAMILY
Entity Type:Organization
Organization Name:FRIENDS OF THE FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MAMFT
Authorized Official - Phone:541-757-1761
Mailing Address - Street 1:685 NW 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6462
Mailing Address - Country:US
Mailing Address - Phone:541-757-1761
Mailing Address - Fax:
Practice Address - Street 1:685 NW 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6462
Practice Address - Country:US
Practice Address - Phone:541-757-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health