Provider Demographics
NPI:1407842578
Name:FAMILY DYNAMICS INC
Entity Type:Organization
Organization Name:FAMILY DYNAMICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-ACP, LMFT
Authorized Official - Phone:972-404-8253
Mailing Address - Street 1:12850 HILLCREST RD
Mailing Address - Street 2:SUITE F-206
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1529
Mailing Address - Country:US
Mailing Address - Phone:972-404-8253
Mailing Address - Fax:972-701-0874
Practice Address - Street 1:12850 HILLCREST RD
Practice Address - Street 2:SUITE F-206
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1529
Practice Address - Country:US
Practice Address - Phone:972-404-8253
Practice Address - Fax:972-701-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX06MROtherBCBS
TX06MROtherBCBS
R59940Medicare UPIN