Provider Demographics
NPI:1497960645
Name:FAMILY RESOURCES ASSOCIATES INC
Entity Type:Organization
Organization Name:FAMILY RESOURCES ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-261-4100
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-0364
Mailing Address - Country:US
Mailing Address - Phone:920-261-4100
Mailing Address - Fax:920-261-8801
Practice Address - Street 1:248 S WISCONSIN DRIVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549
Practice Address - Country:US
Practice Address - Phone:920-261-4100
Practice Address - Fax:920-261-8801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY RESOURCES ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42177600Medicaid
WI326643OtherVALUE OPTIONS
WI546292OtherDEON
WI215861OtherMHN INSURANCE
WI28146151OtherWAUSAU BENEFITS INS
WI68376OtherWPPN MULTIPLAN INS
WI326643OtherVALUE OPTIONS
WI42177600Medicaid