Provider Demographics
NPI:1861589319
Name:FAMILY THERAPY CENTER INC
Entity type:Organization
Organization Name:FAMILY THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-861-9797
Mailing Address - Street 1:8040 HOSBROOK ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2908
Mailing Address - Country:US
Mailing Address - Phone:513-861-9797
Mailing Address - Fax:513-861-3510
Practice Address - Street 1:8040 HOSBROOK ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2908
Practice Address - Country:US
Practice Address - Phone:513-861-9797
Practice Address - Fax:513-861-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9280011Medicare PIN