Family Based Therapy Associates
NPI #1194762005 in Coon Rapids, Minnesota
Provider Information
- NPI Number
- 1194762005
- Entity Type
- Organization
- Organization Name
- Family Based Therapy Associates
- Primary Specialty
- Counselor - Mental Health
- Enumeration Date
- May 31, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 199 COON RAPIDS BLVD NW
- Address 2
- SUITE 306
- City
- Coon Rapids
- State
- Minnesota
- ZIP Code
- 55433-5831
- Phone
- (763) 780-1520
Authorized Official
- Name
- MR. RANDALL D WALLACE, LP
- Title
- DIRECTOR
- Phone
- (763) 780-1520
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Mental Health — Mental Health |
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