Provider Demographics
NPI:1346982402
Name:ONEFAMILY THERAPY & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ONEFAMILY THERAPY & WELLNESS CENTER LLC
Other - Org Name:ONEFAMILY THERAPY & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILYAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDIKADIR
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-615-6848
Mailing Address - Street 1:1751 COUNTY ROAD B W STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4037
Mailing Address - Country:US
Mailing Address - Phone:612-236-4686
Mailing Address - Fax:763-201-7979
Practice Address - Street 1:1751 COUNTY ROAD B W STE 101
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4037
Practice Address - Country:US
Practice Address - Phone:612-236-4686
Practice Address - Fax:763-201-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty