Provider Demographics
NPI:1730480211
Name:FAMILY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD HSSP
Authorized Official - Phone:260-925-2017
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:OH
Mailing Address - Zip Code:43517-0289
Mailing Address - Country:US
Mailing Address - Phone:260-925-2017
Mailing Address - Fax:260-925-9713
Practice Address - Street 1:2355 E CEDAR CANYONS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9330
Practice Address - Country:US
Practice Address - Phone:260-925-2017
Practice Address - Fax:260-925-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042458A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty