Basic Information
Provider Information
NPI: 1912194614
EntityType: 2
ReplacementNPI:  
OrganizationName: FAMILY SERVICES OF NW OHIO SUITE 414 TOLEDO, OHIO 43604
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FOUR COUNTY FAMILY CENTER
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 STRANAHAN SQ STE 414
Address2:  
City: TOLEDO
State: OH
PostalCode: 436041458
CountryCode: US
TelephoneNumber: 4194282322
FaxNumber:  
Practice Location
Address1: 7320 STATE HWY 108
Address2:  
City: WAUSEON
State: OH
PostalCode: 43567
CountryCode: US
TelephoneNumber: 4194282322
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2007
LastUpdateDate: 09/27/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FEARHEILEY
AuthorizedOfficialFirstName: PAMELA
AuthorizedOfficialMiddleName: D
AuthorizedOfficialTitleorPosition: THERAPIST
AuthorizedOfficialTelephone: 4194282322
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: LSW
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000XS0600450OHY AgenciesCommunity/Behavioral Health 

No ID Information.


Home