Provider Demographics
NPI:1972185809
Name:FAMILY THERAPY BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY THERAPY BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARENEQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-438-4572
Mailing Address - Street 1:110 E LEXINGTON ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1745
Mailing Address - Country:US
Mailing Address - Phone:443-438-4572
Mailing Address - Fax:410-483-7359
Practice Address - Street 1:110 E LEXINGTON ST STE 200A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1745
Practice Address - Country:US
Practice Address - Phone:443-438-4572
Practice Address - Fax:410-483-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health