Provider Demographics
NPI:1568791820
Name:ADOLESCENT & FAMILY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:ADOLESCENT & FAMILY COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTRAC
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:TOMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMFT, LPC
Authorized Official - Phone:254-690-2004
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-1511
Mailing Address - Country:US
Mailing Address - Phone:254-690-2004
Mailing Address - Fax:
Practice Address - Street 1:2201 S W S YOUNG DR
Practice Address - Street 2:STE. 105C
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5317
Practice Address - Country:US
Practice Address - Phone:254-690-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty