NPIMap

Organization Active NPI

Therapeutic Services Agency Inc

  • Marriage & Family Therapist
  • Pine City, MN
National Provider Identifier
1497741607
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
THERAPEUTIC SERVICES AGENCY INC
Practice address
220 Railroad St SE
Pine City, MN 55063-1540
Phone
(320) 629-7600
Fax
(651) 925-0071
NPI assigned
Sep 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Stephanie Purdy
Title
Assistant Business Director
Phone
(320) 629-7600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X MN
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X MN
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X MN Primary

Addresses

Primary practice location

220 Railroad St SE
Pine City, MN 55063-1540

Mailing address

220 Railroad St SE
Pine City, MN 55063-1540
Phone (320) 629-7600

Other identifiers 1

IdentifierTypeStateIssuer
757519000MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111109000030 MN Part B Supplier - Clinic/Group Practice 4981877891 Receives reassigned benefits from 20 practitioners
Practice locations: Pine City, MN; Coon Rapids, MN; Duluth, MN; Cambridge, MN

National Provider Directory

National Provider Directory
Tax ID family
Therapeutic Services Agency Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1700 E Rum River Dr S
Cambridge, MN 55008
Phone (651) 224-4114

3915 Coon Rapids Blvd NW
Coon Rapids, MN 55433
Phone (651) 224-4114

3907 Coon Rapids Blvd NW
Coon Rapids, MN 55433

600 E Superior St
Ste 404
Duluth, MN 55802
Phone (218) 302-5096

13265 Sylvan Ave
Lindstrom, MN 55045

38431 Lincoln Trl
North Branch, MN 55056

220 Railroad St SE
Pine City, MN 55063

705 Hillside Ave SW
Pine City, MN 55063

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1497741607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RAILROAD ST SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631540",
            "telephone_number": "320-629-7600",
            "fax_number": "651-925-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 RAILROAD ST SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631540",
            "telephone_number": "320-629-7600",
            "fax_number": "651-925-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPEUTIC SERVICES AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PURDY",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "ASSISTANT BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "320-629-7600"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "757519000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine City, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.