Active NPI
Family Based Therapy Associates
- Mental Health Counselor
- Coon Rapids, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- FAMILY BASED THERAPY ASSOCIATES
- Practice address
- 199 Coon Rapids Blvd NW
Suite 306
Coon Rapids, MN 55433-5831 - Phone
- (763) 780-1520
- Fax
- (763) 780-2114
- NPI assigned
- May 31, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Randall D Wallace, LP
- Title
- Director
- Phone
- (763) 780-1520
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
199 Coon Rapids Blvd NW
Suite 306
Coon Rapids, MN 55433-5831
Mailing address
199 Coon Rapids Blvd NW
Suite 306
Coon Rapids, MN 55433-5831
Phone (763) 780-1520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070110000019 | MN | Part B Supplier - Clinic/Group Practice | 2264432681 |
Receives reassigned benefits from 21 practitioners Practice locations: Cambridge, MN; Chisago City, MN; Coon Rapids, MN |
National Provider Directory
National Provider Directory- Tax ID family
- Family Based Therapy Associates
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Chisago City, MN
- NPI 1891100293
Locations
237 2nd Ave SW
Ste 117
Cambridge, MN 55008
Phone (763) 200-3411
133 2nd Ave SW
Cambridge, MN 55008
Phone (763) 689-9407
237 2nd Ave SW
Cambridge, MN 55008
Phone (651) 245-5217
199 Coon Rapids Blvd NW
Ste 306
Minneapolis, MN 55433
Phone (763) 780-1520
Practitioners & affiliated clinicians
Practitioners 54
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": "1149033600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1194762005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "199 COON RAPIDS BLVD NW",
"address_2": "SUITE 306",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335831",
"telephone_number": "763-780-1520",
"fax_number": "763-780-2114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "199 COON RAPIDS BLVD NW",
"address_2": "SUITE 306",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335831",
"telephone_number": "763-780-1520",
"fax_number": "763-780-2114"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAMILY BASED THERAPY ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-31",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "WALLACE",
"authorized_official_first_name": "RANDALL",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "763-780-1520",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "LP"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, MN
- Robert Ezike, SA-C, CSA
- Samara Fairwell, LADC, LPCC
- Jennifer Lynn Falcon, DPT
- Family & Cosmetic Gentle Dentistry, LTD
- Family & Cosmetic Gentle Dentistry, LTD
- Family Foot and Ankle Clinic, PA
- Family Friendly Chiropractic, Inc.
- Family Life Mental Health Center
- Family Strengths Counseling Group, LLC
- Jessica Fanberg
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.