Provider Demographics
NPI:1467666024
Name:TFP THERAPEUTIC SERVICE, INC.
Entity Type:Organization
Organization Name:TFP THERAPEUTIC SERVICE, INC.
Other - Org Name:THE FAMILY PLACE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SHELLENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC, MAC, CADC
Authorized Official - Phone:541-889-1050
Mailing Address - Street 1:PO BOX V
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914
Mailing Address - Country:US
Mailing Address - Phone:541-889-1050
Mailing Address - Fax:541-889-6524
Practice Address - Street 1:390 NE 2ND STREET
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-889-1050
Practice Address - Fax:541-889-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-01-09
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-10-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
061311000OtherBCBS
ID8051783Medicaid
OR8051783Medicaid
061311000OtherBCBS