Basic Information
| Provider Information | |||||||||
| NPI: | 1407843311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY DIMENSIONS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 EUBANK BLVD NE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871125386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052921554 | ||||||||
| FaxNumber: | 5052921574 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 EUBANK BLVD NE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871125386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052921554 | ||||||||
| FaxNumber: | 5052921574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SPAHR | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5052921554 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LPCC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPCC 1116 | NM | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPCC 1729 | NM | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | LMFT 1307 | NM | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 1041C0700X | I-05493 | NM | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 27933521 | 05 | NM | MEDICAID |