Provider Demographics
NPI:1912194614
Name:FAMILY SERVICES OF NW OHIO SUITE 414 TOLEDO, OHIO 43604
Entity Type:Organization
Organization Name:FAMILY SERVICES OF NW OHIO SUITE 414 TOLEDO, OHIO 43604
Other - Org Name:FOUR COUNTY FAMILY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FEARHEILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:419-428-2322
Mailing Address - Street 1:1 STRANAHAN SQ STE 414
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1458
Mailing Address - Country:US
Mailing Address - Phone:419-428-2322
Mailing Address - Fax:
Practice Address - Street 1:7320 STATE HWY 108
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567
Practice Address - Country:US
Practice Address - Phone:419-428-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0600450251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health