Provider Demographics
NPI:1922449057
Name:HELENA AUTISM THERAPY CENTER, INC
Entity Type:Organization
Organization Name:HELENA AUTISM THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:763-432-3926
Mailing Address - Street 1:5301 E RIVER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1024
Mailing Address - Country:US
Mailing Address - Phone:763-432-3926
Mailing Address - Fax:763-951-2132
Practice Address - Street 1:5301 E RIVER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-1024
Practice Address - Country:US
Practice Address - Phone:763-432-3926
Practice Address - Fax:763-951-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1669251S00000X
MN1111251S00000X
MN5007251S00000X
MN1930251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1295731024Medicaid
MN1346497468Medicaid
MN1265748024Medicaid
MN1184804718Medicaid