Provider Demographics
NPI:1780745489
Name:COMMUNITY AND FAMILY RESOURCE CENTER
Entity type:Organization
Organization Name:COMMUNITY AND FAMILY RESOURCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:765-742-4848
Mailing Address - Street 1:100 SAW MILL RD
Mailing Address - Street 2:P.O. BOX 1186
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5592
Mailing Address - Country:US
Mailing Address - Phone:765-742-4848
Mailing Address - Fax:765-477-9905
Practice Address - Street 1:100 SAW MILL RD
Practice Address - Street 2:SUITE 3200
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5592
Practice Address - Country:US
Practice Address - Phone:765-742-4848
Practice Address - Fax:765-477-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health