Provider Demographics
NPI:1760830640
Name:FAMILY LIFE SERVICES MINISTRIES & TCM, INC.
Entity Type:Organization
Organization Name:FAMILY LIFE SERVICES MINISTRIES & TCM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENINGBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:407-518-9506
Mailing Address - Street 1:721 OAK COMMONS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4186
Mailing Address - Country:US
Mailing Address - Phone:407-518-9505
Mailing Address - Fax:407-518-9507
Practice Address - Street 1:721 OAK COMMONS BLVD STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4186
Practice Address - Country:US
Practice Address - Phone:407-518-9505
Practice Address - Fax:407-518-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
FLMH 11963251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty