Provider Demographics
NPI:1104906098
Name:LDS FAMILY SERVICES
Entity type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:HUISKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:714-444-3463
Mailing Address - Street 1:17350 MOUNT HERRMANN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4114
Mailing Address - Country:US
Mailing Address - Phone:714-444-3463
Mailing Address - Fax:714-444-1768
Practice Address - Street 1:17350 MOUNT HERRMANN ST
Practice Address - Street 2:SUITE A
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4114
Practice Address - Country:US
Practice Address - Phone:714-444-3463
Practice Address - Fax:714-444-1768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)