Provider Demographics
NPI:1588876064
Name:LDS FAMILY SERVICES
Entity type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CABBAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-926-6581
Mailing Address - Street 1:11707 E SPRAGUE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6110
Mailing Address - Country:US
Mailing Address - Phone:509-926-6581
Mailing Address - Fax:509-921-6770
Practice Address - Street 1:100 N MULLAN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6848
Practice Address - Country:US
Practice Address - Phone:509-926-6581
Practice Address - Fax:509-921-6770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-04
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA134514261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)