Provider Demographics
NPI:1710164652
Name:PARKSIDE FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:PARKSIDE FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-266-8880
Mailing Address - Street 1:805 W MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1901
Mailing Address - Country:US
Mailing Address - Phone:517-266-8880
Mailing Address - Fax:517-266-8881
Practice Address - Street 1:805 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1901
Practice Address - Country:US
Practice Address - Phone:517-266-8880
Practice Address - Fax:517-266-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty