NPIMap

Organization Active NPI

Mercy Family Therapy LLC

  • Early Intervention Provider Agency
  • Faribault, MN
National Provider Identifier
1083282628
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
MERCY FAMILY THERAPY LLC
Practice address
218 Central Ave N
Faribault, MN 55021-5278
Phone
(612) 707-1718
NPI assigned
Jun 10, 2021
Last updated
Jun 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Authorized official

Name
Mukhtar Hassan Budul
Title
Director
Phone
(612) 707-1718

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X NU Primary

Addresses

Primary practice location

218 Central Ave N
Faribault, MN 55021-5278

Mailing address

218 Central Ave N
Faribault, MN 55021-5278
Phone (612) 707-1718

National Provider Directory

National Provider Directory

Locations

218 Central Ave N
Faribault, MN 55021
Phone (507) 210-6457

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623283200000",
    "number": "1083282628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 CENTRAL AVE N",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215278",
            "telephone_number": "612-707-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 CENTRAL AVE N",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215278",
            "telephone_number": "612-707-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY FAMILY THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A",
        "authorized_official_last_name": "BUDUL",
        "authorized_official_first_name": "MUKHTAR",
        "authorized_official_middle_name": "HASSAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "612-707-1718"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; 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.