Provider Demographics
NPI:1134203995
Name:PERSONAL & FAMILY COUNSELING SERVICES OF TUSCARAWAS VALLEY, INC
Entity type:Organization
Organization Name:PERSONAL & FAMILY COUNSELING SERVICES OF TUSCARAWAS VALLEY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MSSA, LISW, ACSW
Authorized Official - Phone:330-343-8171
Mailing Address - Street 1:1433 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-1223
Mailing Address - Country:US
Mailing Address - Phone:330-343-8171
Mailing Address - Fax:330-343-8439
Practice Address - Street 1:1433 5TH ST NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-1223
Practice Address - Country:US
Practice Address - Phone:330-343-8171
Practice Address - Fax:330-343-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200795Medicaid
OHPE9242171Medicare PIN