Basic Information
| Provider Information | |||||||||
| NPI: | 1699970608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY & YOUTH INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 365 | ||||||||
| Address2: | 14 SANDALWOOD DRIVE | ||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407888850 | ||||||||
| FaxNumber: | 7407888851 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 SANDALWOOD DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407888850 | ||||||||
| FaxNumber: | 7407888851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LARIMORE | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7407888850 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DMIN MSW LISW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.