Provider Demographics
NPI:1740318716
Name:LDS FAMILY SERVICES
Entity type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:HAGEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-889-0148
Mailing Address - Street 1:547 AMHERST ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4000
Mailing Address - Country:US
Mailing Address - Phone:603-889-0148
Mailing Address - Fax:603-889-4358
Practice Address - Street 1:547 AMHERST ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4000
Practice Address - Country:US
Practice Address - Phone:603-889-0148
Practice Address - Fax:603-889-4358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)