Provider Demographics
NPI:1972636488
Name:THERAPY FOR CHILDREN, ADULTS AND FAMILIES, INC
Entity Type:Organization
Organization Name:THERAPY FOR CHILDREN, ADULTS AND FAMILIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:651-697-9981
Mailing Address - Street 1:1771 ALBERT ST N
Mailing Address - Street 2:
Mailing Address - City:FALCON HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6210
Mailing Address - Country:US
Mailing Address - Phone:651-697-9981
Mailing Address - Fax:
Practice Address - Street 1:1771 ALBERT ST N
Practice Address - Street 2:
Practice Address - City:FALCON HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55113-6210
Practice Address - Country:US
Practice Address - Phone:651-697-9981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN453692000Medicaid