Provider Demographics
NPI:1235531674
Name:DEERFIELD TWP FAMILY COUNSELING CENTER
Entity Type:Organization
Organization Name:DEERFIELD TWP FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-770-3231
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6852
Mailing Address - Country:US
Mailing Address - Phone:513-770-3231
Mailing Address - Fax:513-770-5541
Practice Address - Street 1:7567 CENTRAL PARKE BLVD
Practice Address - Street 2:STE E
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6852
Practice Address - Country:US
Practice Address - Phone:513-770-3231
Practice Address - Fax:513-770-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200489251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health