Provider Demographics
NPI:1639226814
Name:TLC CHILD AND FAMILY SERVICES
Entity Type:Organization
Organization Name:TLC CHILD AND FAMILY SERVICES
Other - Org Name:TLC CHILD AND FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:707-634-9932
Mailing Address - Street 1:1800 GRAVENSTEIN HWY N
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2607
Mailing Address - Country:US
Mailing Address - Phone:707-823-7300
Mailing Address - Fax:707-823-3410
Practice Address - Street 1:1800 GRAVENSTEIN HWY N
Practice Address - Street 2:BLDG A - E
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2607
Practice Address - Country:US
Practice Address - Phone:707-823-7300
Practice Address - Fax:707-823-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health