Autism Family Therapy Inc

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2491 Issued in MN

Legal business name

AUTISM FAMILY THERAPY INC

Practice address

12805 Highway 55
Suite 402
Plymouth, MN 55441-3859

Phone

(612) 597-0459

NPI assigned

Jul 31, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Tamara Faye Phillips, MA, LMFTNPI 1629346952

Title

President

Phone

(612) 597-0459

Specialties & licenses 1

Addresses

Practitioners 1

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

• Tamara Faye Phillips, MA

  • Marriage & Family Therapist
  • Plymouth, MN
  • NPI 1629346952
  NPD (past) Authorized official

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

{
    "created_epoch": "1438300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438300800000",
    "number": "1194101212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6080 IVES LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421241",
            "telephone_number": "612-597-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55",
            "address_2": "SUITE 402",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "612-597-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM FAMILY THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-31",
        "last_updated": "2015-07-31",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_middle_name": "FAYE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-597-0459",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; 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.