Provider Demographics
NPI:1023161288
Name:MID-COLUMBIA CHILD & FAMILY CENTER, INC.
Entity type:Organization
Organization Name:MID-COLUMBIA CHILD & FAMILY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LMFT
Authorized Official - Phone:541-298-5104
Mailing Address - Street 1:3221 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-4373
Mailing Address - Country:US
Mailing Address - Phone:541-298-5104
Mailing Address - Fax:541-298-4108
Practice Address - Street 1:3221 W 10TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-4373
Practice Address - Country:US
Practice Address - Phone:541-298-5104
Practice Address - Fax:541-298-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health