Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST
GREENVILLE OH
45331-1183
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-2319
  • Fax:
Mailing address:
  • Phone: 937-548-9680
  • Fax: 937-548-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JEAN E YOUNG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-548-3806