Provider Demographics
NPI:1073212106
Name:UNITY FAMILY COUPLES & INDIVIDUAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:UNITY FAMILY COUPLES & INDIVIDUAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER, AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BLANCA
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS IN MFT
Authorized Official - Phone:320-260-6772
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-0633
Mailing Address - Country:US
Mailing Address - Phone:320-260-6772
Mailing Address - Fax:855-291-6387
Practice Address - Street 1:1144 29TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2334
Practice Address - Country:US
Practice Address - Phone:320-260-6772
Practice Address - Fax:855-291-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty