Provider Demographics
NPI:1790920353
Name:THERAPEUTIC FAMILY SERVICES
Entity Type:Organization
Organization Name:THERAPEUTIC FAMILY SERVICES
Other - Org Name:TFS OF MALVERN
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CULVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-332-4404
Mailing Address - Street 1:829 HALBERT ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-2607
Mailing Address - Country:US
Mailing Address - Phone:501-332-4400
Mailing Address - Fax:501-332-4403
Practice Address - Street 1:1022 E PAGE AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4362
Practice Address - Country:US
Practice Address - Phone:501-332-4404
Practice Address - Fax:501-332-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C833Medicare UPIN