NPIMap

Organization Active NPI

Family Innovations, Inc.

Doing business as LifeStance Health

  • Counseling Psychologist
  • Anoka, MN
National Provider Identifier
1992862783
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Legal business name
FAMILY INNOVATIONS, INC.
Doing business as
LifeStance Health
Practice address
1833 3Rd Ave
Anoka, MN 55303-2424
Phone
(763) 421-5535
Fax
(763) 433-0226
NPI assigned
Jan 2, 2007
Last updated
Mar 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Ryan Pardo
Title
Chief Legal Officer
Phone
(206) 399-1493

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Professional Counselor 101YP2500X
Clinical Psychologist 103TC0700X
Counseling Psychologist 103TC1900X Primary
Clinical Social Worker 1041C0700X
Marriage & Family Therapist 106H00000X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

1833 3Rd Ave
Anoka, MN 55303-2424

Mailing address

1833 3Rd Ave
Anoka, MN 55303-2424
Phone (763) 421-5535

Other identifiers 7

IdentifierTypeStateIssuer
300P0FAOtherMNBLUE CROSS BLUE SHIELD
48G90FAOtherMNBLUE CROSS BLUE SHIELD
026665500MedicaidMN
086M6FAOtherMNBLUE CROSS BLUE SHIELD
81312OtherMNHEALTH PARTNERS
04033007OtherMNMETROPOLITAN HEALTH PLAN
211588OtherMNCOMPSYCH EAP

Other names 1

  • LifeStance Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190506002814 MN Part B Supplier - Clinic/Group Practice 6204178528 Receives reassigned benefits from 127 practitioners
Practice locations: Anoka, MN; St. Paul, MN; St Louis Park, MN; Saint Paul, MN; Plymouth, MN; Maplewood, MN; Maple Grove, MN; Eden Prairie, MN…

National Provider Directory

National Provider Directory

Locations

1833 3rd Ave
Anoka, MN 55303
Phone (763) 421-5535

6800 78th Ave N
Ste 101
Brooklyn Park, MN 55445
Phone (612) 314-0349

7525 Mitchell Rd
Ste 100
Eden Prairie, MN 55344
Phone (952) 224-2282

7041 20th Ave
Hugo, MN 55038
Phone (651) 407-3631

9325 Upland Ln N
Ste 210
Maple Grove, MN 55369
Phone (612) 453-4966

3601 Minnesota Dr
Ste 170
Minneapolis, MN 55435
Phone (651) 214-8039

3007 Harbor Ln N
Ste 1600
Plymouth, MN 55447
Phone (651) 748-5019

2103 County Road D E
Ste B
Saint Paul, MN 55109
Phone (651) 383-4800

2270 Ford Pkwy
Saint Paul, MN 55116
Phone (651) 696-5000

2270 Ford Pkwy
Ste 106
Saint Paul, MN 55116
Phone (651) 724-9411

360 Sherman St
Ste 390
Saint Paul, MN 55102
Phone (651) 221-0302

5353 Wayzata Blvd
Ste 200
St Louis Park, MN 55416
Phone (833) 934-0244

Practitioners & affiliated clinicians

Practitioners 331

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 331

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1992862783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 3RD AVE",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032424",
            "telephone_number": "763-421-5535",
            "fax_number": "763-433-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 3RD AVE",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032424",
            "telephone_number": "763-421-5535",
            "fax_number": "763-433-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY INNOVATIONS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "PARDO",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "206-399-1493"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "300P0FA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "48G90FA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026665500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "086M6FA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "81312",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METROPOLITAN HEALTH PLAN",
            "identifier": "04033007",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH EAP",
            "identifier": "211588",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeStance Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anoka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.