Provider Demographics
NPI:1538708953
Name:FAMILY BEHAVIORAL HEALTH NETWORK, LLC
Entity type:Organization
Organization Name:FAMILY BEHAVIORAL HEALTH NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DBH
Authorized Official - Phone:541-821-9559
Mailing Address - Street 1:PO BOX 8097
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0997
Mailing Address - Country:US
Mailing Address - Phone:541-821-9559
Mailing Address - Fax:541-702-1236
Practice Address - Street 1:221 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2728
Practice Address - Country:US
Practice Address - Phone:541-821-9559
Practice Address - Fax:541-702-1236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDERSON BEHAVIORAL HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653416Medicaid