Provider Demographics
NPI:1770757023
Name:FAMILY COUNSELING SERVICES
Entity type:Organization
Organization Name:FAMILY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLKERS
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:208-233-9709
Mailing Address - Street 1:4960 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2222
Mailing Address - Country:US
Mailing Address - Phone:208-233-9709
Mailing Address - Fax:
Practice Address - Street 1:4960 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2222
Practice Address - Country:US
Practice Address - Phone:208-233-9709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1127261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010144140OtherREGENCY BLUE SHIELD
IDQ1711OtherBLUE CROSS OF IDAHO