Provider Demographics
NPI:1053620153
Name:FAMILY FOCUS
Entity type:Organization
Organization Name:FAMILY FOCUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:425-771-6600
Mailing Address - Street 1:PO BOX 2784
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-2784
Mailing Address - Country:US
Mailing Address - Phone:206-629-4065
Mailing Address - Fax:360-698-9296
Practice Address - Street 1:9657 FIRDALE AVENUE
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-6519
Practice Address - Country:US
Practice Address - Phone:206-629-4065
Practice Address - Fax:360-698-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty