Provider Demographics
NPI:1639329535
Name:FAMILY CENTER INC
Entity Type:Organization
Organization Name:FAMILY CENTER INC
Other - Org Name:THE FAMILY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:208-360-2365
Mailing Address - Street 1:4648 CEDAR BUTTE CIR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4386
Mailing Address - Country:US
Mailing Address - Phone:208-360-2365
Mailing Address - Fax:
Practice Address - Street 1:534 TREJO ST STE 300
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5405
Practice Address - Country:US
Practice Address - Phone:208-360-2365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health