Provider Demographics
NPI:1851756092
Name:MRM FAMILY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:MRM FAMILY COUNSELING SERVICES, INC.
Other - Org Name:LIVEWELL BEHAVIORAL HEALTH COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-554-9710
Mailing Address - Street 1:1300 E SHAW AVE STE 149
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7903
Mailing Address - Country:US
Mailing Address - Phone:559-473-3632
Mailing Address - Fax:559-554-9711
Practice Address - Street 1:1300 E SHAW AVE
Practice Address - Street 2:SUITE 172
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7917
Practice Address - Country:US
Practice Address - Phone:559-472-3587
Practice Address - Fax:559-472-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
CA80212251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649395419OtherINDIVIDUAL NPI NUMBER