Life Roads, LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

0938 Issued in MN

Legal business name

LIFE ROADS, LLC

Practice address

1068 Lake St S
Suite 109
Forest Lake, MN 55025-2639

Phone

(651) 230-0492

Fax

(651) 982-6035

NPI assigned

Apr 13, 2007

Organization subpart

No

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

Authorized official

Name

Sharon Rose Fries, LMFT

Title

Owner

Phone

(651) 230-0492

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1609091008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 LAKE ST S",
            "address_2": "SUITE 109",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252639",
            "telephone_number": "651-230-0492",
            "fax_number": "651-982-6035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 LAKE ST S",
            "address_2": "SUITE 109",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252639",
            "telephone_number": "651-230-0492",
            "fax_number": "651-982-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ROADS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2012-10-24",
        "status": "A",
        "authorized_official_last_name": "FRIES",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-230-0492",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "0938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1601130-00",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Forest Lake, MN
• Providers in Forest Lake, 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 Oct 24, 2012; 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.