Provider Demographics
NPI:1710069281
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES CA SAN DIEGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:HUISKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:858-467-9170
Mailing Address - Street 1:5675 RUFFIN ROAD,
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1391
Mailing Address - Country:US
Mailing Address - Phone:858-467-9170
Mailing Address - Fax:858-467-9183
Practice Address - Street 1:5675 RUFFIN ROAD,
Practice Address - Street 2:SUITE 325
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1391
Practice Address - Country:US
Practice Address - Phone:858-467-9170
Practice Address - Fax:858-467-9183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)