Provider Demographics
NPI:1063442390
Name:FAMILY SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:FAMILY SERVICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW,LPCC
Authorized Official - Phone:937-222-9481
Mailing Address - Street 1:184 SALEM AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5804
Mailing Address - Country:US
Mailing Address - Phone:937-222-9481
Mailing Address - Fax:937-222-3710
Practice Address - Street 1:184 SALEM AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5804
Practice Address - Country:US
Practice Address - Phone:937-222-9481
Practice Address - Fax:937-222-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC34-16Medicaid
OH10020Medicare UPIN
OHMC34-16Medicaid