Provider Demographics
NPI:1225396005
Name:ADULT PARENT FAMILY CHILD, LLC
Entity Type:Organization
Organization Name:ADULT PARENT FAMILY CHILD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-979-9437
Mailing Address - Street 1:8400 BLANCO RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3055
Mailing Address - Country:US
Mailing Address - Phone:210-979-9437
Mailing Address - Fax:210-979-9839
Practice Address - Street 1:8400 BLANCO RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3055
Practice Address - Country:US
Practice Address - Phone:210-979-9437
Practice Address - Fax:210-979-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102864904Medicaid
TX00790HOtherBLUE CROSS BLUE SHIELD
TX4935407850000OtherTRICARE
TX4935407850000OtherTRICARE