NPIMap

Organization Active NPI

LDS Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brooklyn Center, MN
National Provider Identifier
1043363567
Registry record updated Jun 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LDS FAMILY SERVICES
Practice address
6120 Earle Brown Dr Ste 210
Brooklyn Center, MN 55430-4107
Phone
(763) 560-0900
Fax
(763) 560-1288
NPI assigned
Jan 19, 2007
Organization subpart
Yes
Parent organization
LDS FAMILY SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 6, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark T. Hales, LICSW
Title
Director
Phone
(763) 560-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

6120 Earle Brown Dr Ste 210
Brooklyn Center, MN 55430-4107

Mailing address

6120 Earle Brown Dr Ste 210
Brooklyn Center, MN 55430-4107
Phone (763) 560-0900

Other names 1

  • LDS Family Services Minnesota Agency Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Robert D Smith PHD46 organizations share this tax ID, including this one
Part of
Robert D Smith PHD

Other organizations with this tax ID 45

Organizations that report the same tax identification number in the National Provider Directory.

View all 45

Locations

6120 Earle Brown Dr
Ste 210
Brooklyn Center, MN 55430
Phone (763) 560-0900

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212710400000",
    "number": "1043363567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6120 EARLE BROWN DR STE 210",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554304107",
            "telephone_number": "763-560-0900",
            "fax_number": "763-560-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 EARLE BROWN DR STE 210",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554304107",
            "telephone_number": "763-560-0900",
            "fax_number": "763-560-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LDS FAMILY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LDS FAMILY SERVICES",
        "enumeration_date": "2007-01-19",
        "last_updated": "2008-06-06",
        "status": "A",
        "authorized_official_last_name": "HALES",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "763-560-0900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LDS Family Services Minnesota Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn Center, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.