1710432794 NPI number — JOSEPH & BROOKS FAMILY THERAPY LLC

Table of content: MRS. MELISSA ANNE ALMANZA M.ED., BCBA (NPI 1033496302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710432794 NPI number — JOSEPH & BROOKS FAMILY THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH & BROOKS FAMILY THERAPY LLC
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:
1710432794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1432 CIRCLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60130-2612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-234-2571
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 CIRCLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60130-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-234-2571
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
AL-FUQUAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MARRIAGE AND FAMILY THERAPIST
Authorized Official Telephone Number:
773-234-2571

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  166000906 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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