Provider Demographics
NPI:1912052952
Name:FAMILY THERAPY RESOURCES PA
Entity Type:Organization
Organization Name:FAMILY THERAPY RESOURCES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-835-6950
Mailing Address - Street 1:7400 METRO BLVD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2316
Mailing Address - Country:US
Mailing Address - Phone:952-835-6950
Mailing Address - Fax:952-835-0072
Practice Address - Street 1:7400 METRO BLVD
Practice Address - Street 2:SUITE 413
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2316
Practice Address - Country:US
Practice Address - Phone:952-835-6950
Practice Address - Fax:952-835-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3280103T00000X, 103TF0000X
MN29291041C0700X
MN870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8H297YAOtherBCBS