Provider Demographics
NPI:1922141290
Name:FAMILY SERVICE OF BARTHOLOMEW COUNTY INC
Entity type:Organization
Organization Name:FAMILY SERVICE OF BARTHOLOMEW COUNTY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-372-3745
Mailing Address - Street 1:1531 13TH ST STE 2540
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1305
Mailing Address - Country:US
Mailing Address - Phone:812-372-3745
Mailing Address - Fax:812-954-0888
Practice Address - Street 1:1531 13TH ST STE 2540
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1305
Practice Address - Country:US
Practice Address - Phone:812-372-3745
Practice Address - Fax:812-954-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 104100000X, 1041C0700X, 175T00000X, 101Y00000X, 103TC0700X
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300066526Medicaid
IN234460Medicare PIN