Provider Demographics
NPI:1063732733
Name:FAMILY CHRISTIAN CARE SERVICE
Entity type:Organization
Organization Name:FAMILY CHRISTIAN CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MED LPC
Authorized Official - Phone:936-334-1224
Mailing Address - Street 1:623 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-4849
Mailing Address - Country:US
Mailing Address - Phone:936-334-1224
Mailing Address - Fax:936-334-1224
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-4849
Practice Address - Country:US
Practice Address - Phone:936-334-1224
Practice Address - Fax:936-334-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20158251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179137801Medicaid