NPIMap

Organization Active NPI

Family Based Therapy Associates

  • Community/Behavioral Health Agency
  • Chisago City, MN
National Provider Identifier
1891100293
Registry record updated Jun 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
00789 Issued in MN
Legal business name
FAMILY BASED THERAPY ASSOCIATES
Practice address
11549 Lake LN
Suite 2
Chisago City, MN 55013-9830
Phone
(651) 257-2733
Fax
(651) 257-2783
NPI assigned
Jun 24, 2014
Last updated
Jun 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2014

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

Authorized official

Name
Randall Wallace, LPNPI 1689768707
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)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 00789 MN Primary

Addresses

Primary practice location

11549 Lake LN
Suite 2
Chisago City, MN 55013-9830

Mailing address

199 Coon Rapids Blvd NW
Suite 306
Coon Rapids, MN 55433-5831
Phone (763) 780-1520

National Provider Directory

National Provider Directory
Tax ID family
Family Based Therapy Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

11549 Lake Ln
Ste 2
Chisago City, MN 55013
Phone (651) 257-2733

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403568000000",
    "number": "1891100293",
    "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": "11549 LAKE LN",
            "address_2": "SUITE 2",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139830",
            "telephone_number": "651-257-2733",
            "fax_number": "651-257-2783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY BASED THERAPY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-24",
        "last_updated": "2014-06-24",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "763-780-1520",
        "authorized_official_credential": "LP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "00789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chisago City, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; 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.