Provider Demographics
NPI:1194815969
Name:COMMUNITY BASED FAMILY THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:COMMUNITY BASED FAMILY THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:651-206-3584
Mailing Address - Street 1:9001 E BLOOMINGTON FWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3435
Mailing Address - Country:US
Mailing Address - Phone:651-206-3584
Mailing Address - Fax:
Practice Address - Street 1:9001 E BLOOMINGTON FWY
Practice Address - Street 2:SUITE 140
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3435
Practice Address - Country:US
Practice Address - Phone:651-206-3584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty