Provider Demographics
NPI:1912005059
Name:A FAMILY TYME COUNSELING CENTERS
Entity Type:Organization
Organization Name:A FAMILY TYME COUNSELING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-966-4198
Mailing Address - Street 1:4070 BRIDGE ST
Mailing Address - Street 2:#1
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7557
Mailing Address - Country:US
Mailing Address - Phone:916-966-4198
Mailing Address - Fax:
Practice Address - Street 1:4070 BRIDGE ST
Practice Address - Street 2:#1
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7557
Practice Address - Country:US
Practice Address - Phone:916-966-4198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38147251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare