Family Tree Behavioral Services

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

Legal business name

FAMILY TREE BEHAVIORAL SERVICES

Practice address

4293 144TH Street West
Rosemount, MN 55068

Phone

(612) 636-1186

NPI assigned

Oct 11, 2024

Organization subpart

No

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

Authorized official

Name

Osob Hashi Mohamed

Title

Co-Owner

Phone

(612) 636-1186

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1728604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1972323319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4293 144TH STREET WEST",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "55068",
            "telephone_number": "612-636-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4293 144TH STREET WEST",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "55068",
            "telephone_number": "612-636-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY TREE BEHAVIORAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-11",
        "last_updated": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "OSOB",
        "authorized_official_middle_name": "HASHI",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "612-636-1186"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; 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.