Provider Demographics
NPI:1174649552
Name:COMMUNITY AND FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:COMMUNITY AND FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DESMANGLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LMHC, ACIT
Authorized Official - Phone:765-742-4848
Mailing Address - Street 1:100 SAW MILL RD STE 3200
Mailing Address - Street 2:PO BOX 1186
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5597
Mailing Address - Country:US
Mailing Address - Phone:765-742-4848
Mailing Address - Fax:765-477-9905
Practice Address - Street 1:100 SAW MILL RD STE 3200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5597
Practice Address - Country:US
Practice Address - Phone:765-742-4848
Practice Address - Fax:765-477-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001705A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty