Provider Demographics
NPI:1891132486
Name:FAMILY AND YOUTH INTERVENTION SPECIALIST, INC.
Entity Type:Organization
Organization Name:FAMILY AND YOUTH INTERVENTION SPECIALIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSONDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-259-9737
Mailing Address - Street 1:1206 SILVER MOON TRL
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3969
Mailing Address - Country:US
Mailing Address - Phone:404-259-9737
Mailing Address - Fax:678-398-3396
Practice Address - Street 1:1206 SILVER MOON TRL
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3969
Practice Address - Country:US
Practice Address - Phone:404-259-9737
Practice Address - Fax:678-398-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAJ6Y39UB2Medicare PIN