Provider Demographics
NPI:1518053834
Name:FAMILY ADOLESCENTS AND CHILDREN THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:FAMILY ADOLESCENTS AND CHILDREN THERAPY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BLARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:952-938-2600
Mailing Address - Street 1:1385 MENDOTA HEIGHTS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1289
Mailing Address - Country:US
Mailing Address - Phone:651-379-9800
Mailing Address - Fax:651-405-0358
Practice Address - Street 1:4655 NICOLS RD
Practice Address - Street 2:STE 206
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3425
Practice Address - Country:US
Practice Address - Phone:952-936-2800
Practice Address - Fax:651-405-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7571675251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN326658301Medicaid
MN326658300Medicaid