Provider Demographics
NPI:1245860949
Name:FTS OUTPATIENT LLC
Entity type:Organization
Organization Name:FTS OUTPATIENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-562-2108
Mailing Address - Street 1:115 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1711
Mailing Address - Country:US
Mailing Address - Phone:757-562-2108
Mailing Address - Fax:
Practice Address - Street 1:115 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1711
Practice Address - Country:US
Practice Address - Phone:757-562-2108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY THERAPEUTIC SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty