Provider Demographics
NPI:1215121967
Name:FAMILY BEHAVIORAL RESOURCES, LLC
Entity type:Organization
Organization Name:FAMILY BEHAVIORAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:920-430-9100
Mailing Address - Street 1:2301 RIVERSIDE DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1907
Mailing Address - Country:US
Mailing Address - Phone:920-430-9100
Mailing Address - Fax:920-430-9101
Practice Address - Street 1:2301 RIVERSIDE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1907
Practice Address - Country:US
Practice Address - Phone:920-430-9100
Practice Address - Fax:920-430-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2480251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42232600Medicaid