1669732004 NPI number — FAMILY FIRST COUNSELING SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669732004 NPI number — FAMILY FIRST COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669732004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1338 PORT MALABAR BLVD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32905-5259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-720-1709
Provider Business Mailing Address Fax Number:
321-733-1860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2194 HWY A1A STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN HARBOUR BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32937-4931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-720-1708
Provider Business Practice Location Address Fax Number:
321-773-5497
Provider Enumeration Date:
05/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BASHIR
Authorized Official First Name:
RAHILA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
321-720-1709

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MH7753 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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