=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659417806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY OPTIONS PROVIDERS, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 09/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 WHITESTICK RD
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-254-9610
-----------------------------------------------------
Fax | 304-254-9099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 N EISENHOWER DR SUITE A
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801-3146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-254-9610
-----------------------------------------------------
Fax | 304-254-9099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KATHLEEN TORRICO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-254-9610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 355
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------