Provider Demographics
NPI:1225401441
Name:COUNSELING & FAMILY CENTERED SERVICES, INC.
Entity Type:Organization
Organization Name:COUNSELING & FAMILY CENTERED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KALISTA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, SANE
Authorized Official - Phone:641-394-2505
Mailing Address - Street 1:951 N LINN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-1212
Mailing Address - Country:US
Mailing Address - Phone:641-394-2505
Mailing Address - Fax:
Practice Address - Street 1:951 N LINN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-1212
Practice Address - Country:US
Practice Address - Phone:641-394-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1012617Medicaid