Provider Demographics
NPI:1891849303
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-371-1000
Mailing Address - Street 1:3263 FRASER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-1217
Mailing Address - Country:US
Mailing Address - Phone:303-371-1000
Mailing Address - Fax:303-371-1002
Practice Address - Street 1:3263 FRASER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1217
Practice Address - Country:US
Practice Address - Phone:303-371-1000
Practice Address - Fax:303-371-1002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992679261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)