Provider Demographics
NPI:1326227547
Name:EMQ CHILDREN FAMILY SERVICES
Entity Type:Organization
Organization Name:EMQ CHILDREN FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARQUES
Authorized Official - Middle Name:DEMONT
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-628-5559
Mailing Address - Street 1:251 LLEWELLYN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1940
Mailing Address - Country:US
Mailing Address - Phone:408-364-4190
Mailing Address - Fax:510-505-0390
Practice Address - Street 1:251 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1940
Practice Address - Country:US
Practice Address - Phone:408-364-4190
Practice Address - Fax:510-505-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health