Provider Demographics
NPI:1275837676
Name:FAMILY TIES COUNSELING, INC.
Entity Type:Organization
Organization Name:FAMILY TIES COUNSELING, INC.
Other - Org Name:FAMILY TIES COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:719-477-0550
Mailing Address - Street 1:10 BOULDER CRESCENT ST STE 102H
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3345
Mailing Address - Country:US
Mailing Address - Phone:719-477-0550
Mailing Address - Fax:719-471-7840
Practice Address - Street 1:10 BOULDER CRESCENT ST STE 102H
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3345
Practice Address - Country:US
Practice Address - Phone:719-477-0550
Practice Address - Fax:719-471-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2363251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO154469Medicaid