Provider Demographics
NPI:1811002769
Name:FAMILY SERVICE ASOCIATION OF THE WABASH VALLEY, INC.
Entity Type:Organization
Organization Name:FAMILY SERVICE ASOCIATION OF THE WABASH VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAC
Authorized Official - Phone:812-232-4349
Mailing Address - Street 1:1111 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3211
Mailing Address - Country:US
Mailing Address - Phone:812-232-4349
Mailing Address - Fax:812-232-2308
Practice Address - Street 1:1111 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3211
Practice Address - Country:US
Practice Address - Phone:812-232-4349
Practice Address - Fax:812-232-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200232410AMedicaid