Provider Demographics
NPI:1952548059
Name:FAMILY FOCUS
Entity Type:Organization
Organization Name:FAMILY FOCUS
Other - Org Name:ELLEN L MALONE SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWER/SOLE MBR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LCSW, ACSW
Authorized Official - Phone:228-497-8180
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-0019
Mailing Address - Country:US
Mailing Address - Phone:228-497-8180
Mailing Address - Fax:228-497-6594
Practice Address - Street 1:1408 HIGHWAY 90
Practice Address - Street 2:SUITE 2
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5456
Practice Address - Country:US
Practice Address - Phone:228-497-8180
Practice Address - Fax:228-497-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC2571251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07933592Medicaid