Provider Demographics
NPI:1124772637
Name:FAMILY LIFE MINISTRIES INC
Entity type:Organization
Organization Name:FAMILY LIFE MINISTRIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:607-776-4151
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-0506
Mailing Address - Country:US
Mailing Address - Phone:607-776-4151
Mailing Address - Fax:607-776-2969
Practice Address - Street 1:7634 CAMPBELL CREEK RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7612
Practice Address - Country:US
Practice Address - Phone:607-776-4151
Practice Address - Fax:607-776-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)