Provider Demographics
NPI:1467895235
Name:FAMILY AND COMMUNITY THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY AND COMMUNITY THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-546-5242
Mailing Address - Street 1:107 WARD TER
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-1707
Mailing Address - Country:US
Mailing Address - Phone:314-546-5242
Mailing Address - Fax:314-222-0514
Practice Address - Street 1:107 WARD TER
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1707
Practice Address - Country:US
Practice Address - Phone:314-546-5242
Practice Address - Fax:314-222-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty