Organization
FAMILY CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN M ELLIS (PROVIDER ENGAGEMENT & CREDENTIALING)
(765) 540-2100
Entity
Organization
Contact information
Practice address
1910 S STAPLEY DR STE 209, MESA, AZ 85204-6679
(719) 540-2100
Mailing address
2860 S CIRCLE DR STE 109, COLORADO SPRINGS, CO 80906-4195
(719) 540-2100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
01/04/2024
Last updated
11/07/2024
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