Provider Demographics
NPI:1689990665
Name:MANKATO MARRIAGE AND FAMILY THERAPY CENTER PLLC
Entity Type:Organization
Organization Name:MANKATO MARRIAGE AND FAMILY THERAPY CENTER PLLC
Other - Org Name:MANKATO MARRIAGE AND FAMILY THERAPY CENTER PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAPKING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:507-625-4884
Mailing Address - Street 1:1207 CALEDONIA STREET
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-625-4884
Mailing Address - Fax:507-625-6311
Practice Address - Street 1:1207 CALEDONIA STREET
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-625-4884
Practice Address - Fax:507-625-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN965251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1669456885Medicaid
MN206968700Medicaid