Provider Demographics
NPI:1225103914
Name:FAMILY SERVICES OF THE MID-SOUTH
Entity Type:Organization
Organization Name:FAMILY SERVICES OF THE MID-SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:901-324-3637
Mailing Address - Street 1:2430 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3246
Mailing Address - Country:US
Mailing Address - Phone:901-324-3637
Mailing Address - Fax:901-324-9114
Practice Address - Street 1:2430 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3246
Practice Address - Country:US
Practice Address - Phone:901-324-3637
Practice Address - Fax:901-324-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL214 096 6397251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0530Medicare ID - Type UnspecifiedGROUP