MEDICARE: FAMILY SERVICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	MI
2	101YS0200X	School Counselor	MI
3	1041S0200X	School Social Worker	MI
4	251S00000X	Community/Behavioral Health Agency	MI
5	1041C0700X	Clinical Social Worker	MI

General Provider Information

NPI Number	:	1649602350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY SERVICE

Provider Business Mailing Address
First Line	:	1235 LAWNDALE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48209-1727
Country	:	US
Telephone Number	:	313-841-6254
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 PARSONS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2002
Country	:	US
Telephone Number	:	313-831-1000
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DEBORAH SNYDER
Credential	:
Telephone Number	:	248-990-4337

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	08/05/2013

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Directions to “FAMILY SERVICE ” Practice Location

Language	Start Address	Practice Location

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