Provider Demographics
NPI:1467925420
Name:THE FAMILY PLACE D/B/A TFP SERVICES THERAPEUTIC
Entity Type:Organization
Organization Name:THE FAMILY PLACE D/B/A TFP SERVICES THERAPEUTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TESS
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHELLENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC(ID), LPC(OR)
Authorized Official - Phone:541-889-1050
Mailing Address - Street 1:P.O. BOX V, (ONTARIO)
Mailing Address - Street 2:390 NE 2ND ST.
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 ST.
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:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805178300Medicaid