Basic Information
| Provider Information | |||||||||
| NPI: | 1154626893 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY FIRST CENTER FOR AUTISM AND CHILD DEVELOPMENT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5863 NW 72ND ST | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641511483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169848282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5863 NW 72ND ST | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641511483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169848282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2011 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | WEIERS | ||||||||
| AuthorizedOfficialFirstName: | FARRELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8168769352 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.