Provider Demographics
NPI:1457476475
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES CA SAN JOSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELING GROUP MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-682-6530
Mailing Address - Street 1:6840 VIA DEL ORO
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1357
Mailing Address - Country:US
Mailing Address - Phone:408-361-0133
Mailing Address - Fax:408-361-0132
Practice Address - Street 1:6840 VIA DEL ORO
Practice Address - Street 2:SUITE 225
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1357
Practice Address - Country:US
Practice Address - Phone:408-361-0133
Practice Address - Fax:408-361-0132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)