Provider Demographics
NPI:1295116408
Name:HELENA AUTISM THERAPY CENTER
Entity type:Organization
Organization Name:HELENA AUTISM THERAPY CENTER
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:M
Authorized Official - Last Name:TARRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-994-3367
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00985252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1285017426Medicaid