Healthcare Provider Details

I. General information

NPI: 1841231677
Provider Name (Legal Business Name): FAMILY SERVICE ASSOCIATION OF MONROE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 7TH ST SUITE 104
BLOOMINGTON IN
47404-3834
US

IV. Provider business mailing address

120 W 7TH ST SUITE 104
BLOOMINGTON IN
47404-3834
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-1551
  • Fax: 812-334-8398
Mailing address:
  • Phone: 812-339-1551
  • Fax: 812-334-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DONNA GRAVES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 812-339-1551