MEDICARE: FAMILY THERAPY CENTER INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1861589319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	8040 HOSBROOK ROAD
Second Line	:	SUITE 320
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2908
Country	:	US
Telephone Number	:	513-861-9797
Fax Number	:	513-861-3510

Provider Business Practice Location Address
First Line	:	8040 HOSBROOK ROAD
Second Line	:	SUITE 320
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2908
Country	:	US
Telephone Number	:	513-861-9797
Fax Number	:	513-861-3510

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MRS. ANNETTE L RAVER
Credential	:
Telephone Number	:	513-861-9797

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/03/2007

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