Provider Demographics
NPI:1942587217
Name:FAMILY SERVICE AGENCY
Entity Type:Organization
Organization Name:FAMILY SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:602-264-9891
Mailing Address - Street 1:15031 N 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5282
Mailing Address - Country:US
Mailing Address - Phone:928-266-4151
Mailing Address - Fax:
Practice Address - Street 1:943 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4441
Practice Address - Country:US
Practice Address - Phone:602-264-9891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12450305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service