Provider Demographics
NPI:1518970458
Name:FAMILY TREATMENT PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:FAMILY TREATMENT PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:JUDSON-HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-330-0901
Mailing Address - Street 1:2175 290TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-9012
Mailing Address - Country:US
Mailing Address - Phone:641-330-0901
Mailing Address - Fax:641-394-3759
Practice Address - Street 1:23 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-2115
Practice Address - Country:US
Practice Address - Phone:641-330-0901
Practice Address - Fax:641-394-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00969103TC0700X
IA015081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAAPPLIEDMedicaid
IAAPPLIEDMedicare ID - Type Unspecified