Family Life Mental Health Center

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8 Issued in MN

Legal business name

FAMILY LIFE MENTAL HEALTH CENTER

Practice address

1930 Coon Rapids Blvd NW
Coon Rapids, MN 55433-4708

Phone

(763) 427-7964

Fax

(763) 427-7976

NPI assigned

Jul 5, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Sullivan, LICSWNPI 1548224355

Title

Executive Director

Phone

(763) 427-7964

Specialties & licenses 1

Addresses

Locations

Practitioners 4

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.

• Robert Allen Sullivan, LICSW

  • Clinical Social Worker
  • Coon Rapids, MN
  • NPI 1548224355
  Authorized official Same address or phone
• Marlene Ann Beecroft, MSSW, LICSW

  • Clinical Social Worker
  • Coon Rapids, MN
  • NPI 1194867432
  NPD (past)
• Elizabeth Ruskin Shanklin, LICSW

  • Social Worker
  • Coon Rapids, MN
  • NPI 1841398260
  NPD (past)
• Jessica Anne Zingelman, LICSW

  • Social Worker
  • Maple Grove, MN
  • NPI 1932161767
  NPD (past)

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760489751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334708",
            "telephone_number": "763-427-7964",
            "fax_number": "763-427-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334708",
            "telephone_number": "763-427-7964",
            "fax_number": "763-427-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY LIFE MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "763-427-7964",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "8",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family & Cosmetic Gentle Dentistry, LTD ('Gentle Dentistry')
• Family & Cosmetic Gentle Dentistry, LTD
• Family Based Therapy Associates
• Family Foot and Ankle Clinic, PA
• Family Friendly Chiropractic, Inc.
• Family Strengths Counseling Group, LLC
• Jessica Fanberg
• Autumn E. S. R. Fancher, LPCC
• Deka Farah
• Daniel McGeary Farber, MD

• Clinical Social Worker in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Clinical Social Worker in Minnesota

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.