Provider Demographics
NPI:1083282628
Name:MERCY FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:MERCY FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUKHTAR
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:BUDUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-707-1718
Mailing Address - Street 1:218 CENTRAL AVE N
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5278
Mailing Address - Country:US
Mailing Address - Phone:612-707-1718
Mailing Address - Fax:
Practice Address - Street 1:218 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5278
Practice Address - Country:US
Practice Address - Phone:612-707-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency