Provider Demographics
NPI:1487128070
Name:FAMILY AND CHILDREN'S PLACE
Entity type:Organization
Organization Name:FAMILY AND CHILDREN'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRISEYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAS
Authorized Official - Suffix:
Authorized Official - Credentials:CSW, LSW
Authorized Official - Phone:502-893-3900
Mailing Address - Street 1:100 W COURT AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3532
Mailing Address - Country:US
Mailing Address - Phone:502-893-3900
Mailing Address - Fax:
Practice Address - Street 1:100 W COURT AVE STE 102
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3532
Practice Address - Country:US
Practice Address - Phone:502-893-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)