Provider Demographics
NPI:1538464359
Name:THE FAMILY CONNECTION, LLC
Entity Type:Organization
Organization Name:THE FAMILY CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HIEBSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-310-3527
Mailing Address - Street 1:2295 LAWRENCE 2140
Mailing Address - Street 2:
Mailing Address - City:SARCOXIE
Mailing Address - State:MO
Mailing Address - Zip Code:64862-8249
Mailing Address - Country:US
Mailing Address - Phone:417-310-3527
Mailing Address - Fax:866-826-4066
Practice Address - Street 1:2295 LAWRENCE 2140
Practice Address - Street 2:
Practice Address - City:SARCOXIE
Practice Address - State:MO
Practice Address - Zip Code:64862-8249
Practice Address - Country:US
Practice Address - Phone:417-310-3527
Practice Address - Fax:866-826-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1761271540Medicaid