Provider Demographics
NPI:1174036099
Name:FAMILY RESTORATION & EMPOWERMENT ENTERPRISES
Entity Type:Organization
Organization Name:FAMILY RESTORATION & EMPOWERMENT ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-365-3964
Mailing Address - Street 1:2615 19TH STREET PL SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3953
Mailing Address - Country:US
Mailing Address - Phone:253-365-3964
Mailing Address - Fax:
Practice Address - Street 1:1554 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3250
Practice Address - Country:US
Practice Address - Phone:253-365-3964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60806253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty