MEDICARE: FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1649624115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.

Provider Business Mailing Address
First Line	:	5735 MEEKER RD
Second Line	:
City	:	GREENVILLE
State	:	OH
Zip	:	45331-1180
Country	:	US
Telephone Number	:	937-548-9680
Fax Number	:	937-548-2087

Provider Business Practice Location Address
First Line	:	1101 JACKSON ST
Second Line	:
City	:	GREENVILLE
State	:	OH
Zip	:	45331-1183
Country	:	US
Telephone Number	:	937-547-2319
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JEAN E YOUNG
Credential	:
Telephone Number	:	937-548-3806

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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