Provider Demographics
NPI:1669030367
Name:CHILDREN & FAMILY SERVICES
Entity Type:Organization
Organization Name:CHILDREN & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LBSW-IPR
Authorized Official - Phone:817-789-0116
Mailing Address - Street 1:PO BOX 8212
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-0212
Mailing Address - Country:US
Mailing Address - Phone:817-789-0116
Mailing Address - Fax:
Practice Address - Street 1:10129 SOUTH RACE STREET
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140
Practice Address - Country:US
Practice Address - Phone:817-789-0116
Practice Address - Fax:817-349-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189803301Medicaid