NPIMap

Organization Active NPI

Northeast Youth & Family Services

  • Community Health Clinic/Center
  • White Bear Lake, MN
National Provider Identifier
1073098810
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
NORTHEAST YOUTH & FAMILY SERVICES
Practice address
1280 N Birch Lake Blvd
White Bear Lake, MN 55110-6708
Phone
(651) 429-8544
Fax
(651) 407-5301
NPI assigned
Sep 27, 2018
Last updated
Sep 27, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST YOUTH & FAMILY SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Authorized official

Name
Ms. Lisa M Paquet, BA
Title
Clinic Operations Manager
Phone
(651) 379-3443

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU Primary
Clinical Child & Adolescent Psychologist 103TC2200X NU

Addresses

Primary practice location

1280 N Birch Lake Blvd
White Bear Lake, MN 55110-6708

Mailing address

3490 Lexington Ave N Ste 205
Shoreview, MN 55126-8044
Phone (651) 486-3808

Other identifiers 1

IdentifierTypeStateIssuer
A880726400OtherMNUPI

National Provider Directory

National Provider Directory
Tax ID family
Northwest Sub Youth Ser2 organizations share this tax ID, including this one
Part of
Northwest Sub Youth Ser

Other organizations with this tax ID 1

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

Locations

3490 Lexington Ave N
Ste 205
Shoreview, MN 55126
Phone (651) 486-3808

1280 N Birch Lake Blvd
White Bear Lk, MN 55110
Phone (651) 429-8544

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1538006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538006400000",
    "number": "1073098810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3490 LEXINGTON AVE N STE 205",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551268044",
            "telephone_number": "651-486-3808",
            "fax_number": "651-486-3858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 N BIRCH LAKE BLVD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551106708",
            "telephone_number": "651-429-8544",
            "fax_number": "651-407-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST YOUTH & FAMILY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST YOUTH & FAMILY SERVICES",
        "enumeration_date": "2018-09-27",
        "last_updated": "2018-09-27",
        "status": "A",
        "authorized_official_last_name": "PAQUET",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINIC OPERATIONS MANAGER",
        "authorized_official_telephone_number": "651-379-3443",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPI",
            "identifier": "A880726400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; 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.