Provider Demographics
NPI:1396010617
Name:CHILD & FAMILY THERAPY CONSULTANTS
Entity Type:Organization
Organization Name:CHILD & FAMILY THERAPY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GRACHELLE
Authorized Official - Middle Name:ALYCE
Authorized Official - Last Name:SHERBURNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-352-3558
Mailing Address - Street 1:114 VINE ST
Mailing Address - Street 2:P.O. BOX 373
Mailing Address - City:GOBLES
Mailing Address - State:MI
Mailing Address - Zip Code:49055-9693
Mailing Address - Country:US
Mailing Address - Phone:269-352-3558
Mailing Address - Fax:
Practice Address - Street 1:114 VINE ST
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055-9693
Practice Address - Country:US
Practice Address - Phone:269-352-3558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090517251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health