Provider Demographics
NPI:1164779377
Name:LAE FAMILY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:LAE FAMILY COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-342-8344
Mailing Address - Street 1:45080 GOLF CENTER PARKWAY
Mailing Address - Street 2:SUITE H
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-342-8344
Mailing Address - Fax:888-279-5997
Practice Address - Street 1:45080 GOLF CENTER PARKWAY
Practice Address - Street 2:SUITE H
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-342-8344
Practice Address - Fax:888-279-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS207661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty