Provider Demographics
NPI:1932225141
Name:FAMILY GUIDANCE CENTER FOR BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:FAMILY GUIDANCE CENTER FOR BEHAVIORAL HEALTHCARE
Other - Org Name:FAMILY GUIDANCE CENTER OF ST. JOSEPH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-364-1501
Mailing Address - Street 1:724 N 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2604
Mailing Address - Country:US
Mailing Address - Phone:816-364-1501
Mailing Address - Fax:816-364-4211
Practice Address - Street 1:724 N 22ND STREET
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2604
Practice Address - Country:US
Practice Address - Phone:816-364-1501
Practice Address - Fax:816-364-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO560824906Medicaid
3940000Medicare PIN