Provider Demographics
NPI:1275647604
Name:FAMILY THERAPY & RECOVERY CTR
Entity Type:Organization
Organization Name:FAMILY THERAPY & RECOVERY CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:ONDICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:952-545-8833
Mailing Address - Street 1:5353 GAMBLE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1539
Mailing Address - Country:US
Mailing Address - Phone:952-545-8833
Mailing Address - Fax:
Practice Address - Street 1:5353 GAMBLE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1539
Practice Address - Country:US
Practice Address - Phone:952-545-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN121015OtherMN CARE
MN7H008FAOtherBCBSIMN