Provider Demographics
NPI:1285761684
Name:THE FAMILY COUNSELING PLACE
Entity type:Organization
Organization Name:THE FAMILY COUNSELING PLACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:TANNER
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:972-394-2137
Mailing Address - Street 1:3620 NORTH JOSEY LANE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3151
Mailing Address - Country:US
Mailing Address - Phone:972-394-2137
Mailing Address - Fax:972-492-7865
Practice Address - Street 1:3620 NORTH JOSEY LANE
Practice Address - Street 2:SUITE 114
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3151
Practice Address - Country:US
Practice Address - Phone:972-394-2137
Practice Address - Fax:972-492-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162751041C0700X
OK29961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0040QAOtherBLUE CROSS BLUE SHIELD
TX295539OtherVALUE OPTIONS