Provider Demographics
NPI:1174634240
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES MO INDEPENDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-461-5512
Mailing Address - Street 1:517 W WALNUT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-3632
Mailing Address - Country:US
Mailing Address - Phone:816-461-5512
Mailing Address - Fax:816-461-4907
Practice Address - Street 1:517 W WALNUT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3632
Practice Address - Country:US
Practice Address - Phone:816-461-5512
Practice Address - Fax:816-461-4907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)