Provider Demographics
NPI:1154652253
Name:FAMILY AND CHILDREN'S PLACE
Entity Type:Organization
Organization Name:FAMILY AND CHILDREN'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRESERVATION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:812-944-6120
Mailing Address - Street 1:2818 GRANT LINE RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2492
Mailing Address - Country:US
Mailing Address - Phone:812-944-6120
Mailing Address - Fax:812-941-5726
Practice Address - Street 1:2818 GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2492
Practice Address - Country:US
Practice Address - Phone:812-944-6120
Practice Address - Fax:812-941-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INNA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100415400Medicaid