Provider Demographics
NPI:1568684678
Name:FAMILY FOCUS
Entity Type:Organization
Organization Name:FAMILY FOCUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NORTHERN DIVISION DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:218-740-3146
Mailing Address - Street 1:2800 UNIVERSITY AVE SE
Mailing Address - Street 2:204
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3232
Mailing Address - Country:US
Mailing Address - Phone:612-331-4429
Mailing Address - Fax:
Practice Address - Street 1:15 BUCHANAN ST
Practice Address - Street 2:212
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2328
Practice Address - Country:US
Practice Address - Phone:218-740-3146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10075603251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health