Healthcare Provider Details

I. General information

NPI: 1235389321
Provider Name (Legal Business Name): FAMILY COUNSELING SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILLIS AVE
BOONVILLE IN
47601-2226
US

IV. Provider business mailing address

PO BOX 182
NEWBURGH IN
47629-0182
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-7131
  • Fax: 812-897-7456
Mailing address:
  • Phone: 812-897-7131
  • Fax: 812-897-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number340030066A
License Number StateIN

VIII. Authorized Official

Name: MR. ALLEN MONROE TOY II
Title or Position: THERAPIST
Credential: LCSW
Phone: 812-897-7131