Provider Demographics
NPI:1912060393
Name:FAMILY SERVICE OF THE TRI-CITIES
Entity Type:Organization
Organization Name:FAMILY SERVICE OF THE TRI-CITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:J
Authorized Official - Last Name:THERIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-791-3322
Mailing Address - Street 1:39899 BALENTINE DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5355
Mailing Address - Country:US
Mailing Address - Phone:510-791-3322
Mailing Address - Fax:510-791-3325
Practice Address - Street 1:39899 BALENTINE DR
Practice Address - Street 2:SUITE 212
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5355
Practice Address - Country:US
Practice Address - Phone:510-791-3322
Practice Address - Fax:510-791-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty