Provider Demographics
NPI:1689432270
Name:INFOCUS FAMILY MATTERS
Entity Type:Organization
Organization Name:INFOCUS FAMILY MATTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:KILGORE
Authorized Official - Last Name:MCDANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:848-241-2959
Mailing Address - Street 1:2840 OAK HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-9552
Mailing Address - Country:US
Mailing Address - Phone:848-241-2959
Mailing Address - Fax:
Practice Address - Street 1:2840 OAK HAVEN CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-9552
Practice Address - Country:US
Practice Address - Phone:848-241-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1174182505Medicaid