Family Revelations Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

3335 Issued in MN

Legal business name

FAMILY REVELATIONS INC.

Practice address

1705 Cope Ave E Ste I
Maplewood, MN 55109-2639

Phone

(651) 319-6484

Fax

(651) 925-0442

NPI assigned

May 18, 2017

Organization subpart

No

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

Authorized official

Name

Bernie Jerome Menge, MA. LMFTNPI 1134490469

Title

Owner / Partner

Phone

(651) 319-6484

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

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

• Bernie Jerome Menge, MA. LMFT

  • Marriage & Family Therapist
  • Hastings, MN
  • NPI 1134490469
  Medicare reassignment NPD Authorized official
• Maylee Chang Thao, LPCC

  • Professional Counselor
  • Woodbury, MN
  • NPI 1326458340
  NPD (past)

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

{
    "created_epoch": "1495065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1790212926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 COPE AVE E STE I",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092639",
            "telephone_number": "651-319-6484",
            "fax_number": "651-925-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 COPE AVE E STE I",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092639",
            "telephone_number": "651-319-6484",
            "fax_number": "651-925-0442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1303 S Frontage Rd Ste 275",
            "address_purpose": "LOCATION",
            "city": "Hastings",
            "state": "MN",
            "postal_code": "550332655",
            "country_code": "US",
            "telephone_number": "651-319-6484",
            "fax_number": "651-925-0442",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1303 S Frontage Rd Ste 275",
            "address_purpose": "LOCATION",
            "city": "Hastings",
            "state": "MN",
            "postal_code": "550332483",
            "country_code": "US",
            "telephone_number": "651-319-6484",
            "fax_number": "651-925-0442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY REVELATIONS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-18",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "MENGE",
        "authorized_official_first_name": "BERNIE",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "OWNER / PARTNER",
        "authorized_official_telephone_number": "651-319-6484",
        "authorized_official_credential": "MA. LMFT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "3335",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "3335",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "3335",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134490469",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Falk
• Family & Cosmetic Gentle Dentistry, LTD
• Family First Chiropractic & Wellness Center
• Family Healthservices Minnesota, P.a
• Family Healthservices Minnesota, P.a.
• Ilana Lynn Farb, DNP, RN
• Geoffrey S. Fasen, M.D.
• Maxwell Aaron Feld, DC
• Derrick D Fenchel, MD
• Rhonda S Fender, NNP

• Adult Mental Health Clinic/Center in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Adult Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.