Provider Demographics
NPI:1700288081
Name:FAMILY COUNSELING AND MEDIATION SERVICES LLC
Entity Type:Organization
Organization Name:FAMILY COUNSELING AND MEDIATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:SCHEID
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CAADC, NCC
Authorized Official - Phone:269-488-5903
Mailing Address - Street 1:4017 W MAIN ST STE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3731
Mailing Address - Country:US
Mailing Address - Phone:269-488-5903
Mailing Address - Fax:269-775-1288
Practice Address - Street 1:4017 W MAIN ST STE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3731
Practice Address - Country:US
Practice Address - Phone:269-488-5903
Practice Address - Fax:269-775-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009641251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health