Provider Demographics
NPI:1053883439
Name:FAIR CLINICAL SERVICES, LLC
Entity type:Organization
Organization Name:FAIR CLINICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:419-740-3052
Mailing Address - Street 1:2211 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3637
Mailing Address - Country:US
Mailing Address - Phone:419-740-3052
Mailing Address - Fax:419-893-0475
Practice Address - Street 1:2211 RIVER RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3637
Practice Address - Country:US
Practice Address - Phone:419-740-3052
Practice Address - Fax:419-893-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-22
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346995Medicaid