Provider Demographics
NPI:1134271695
Name:FAMILY TREE COUNSELING ASSOCIATES, PLC
Entity type:Organization
Organization Name:FAMILY TREE COUNSELING ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEN BERGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:802-223-7364
Mailing Address - Street 1:250 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4258
Mailing Address - Country:US
Mailing Address - Phone:802-223-7364
Mailing Address - Fax:802-223-8679
Practice Address - Street 1:250 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4258
Practice Address - Country:US
Practice Address - Phone:802-223-7364
Practice Address - Fax:802-223-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00007701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT58392OtherBCBS OF VT
VT1008150Medicaid