Provider Demographics
NPI:1043363567
Name:LDS FAMILY SERVICES
Entity type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HALES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:763-560-0900
Mailing Address - Street 1:6120 EARLE BROWN DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4107
Mailing Address - Country:US
Mailing Address - Phone:763-560-0900
Mailing Address - Fax:763-560-1288
Practice Address - Street 1:6120 EARLE BROWN DR STE 210
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-4107
Practice Address - Country:US
Practice Address - Phone:763-560-0900
Practice Address - Fax:763-560-1288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)