Healthcare Provider Details

I. General information

NPI: 1912052952
Provider Name (Legal Business Name): FAMILY THERAPY RESOURCES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 METRO BLVD SUITE 413
EDINA MN
55439-2316
US

IV. Provider business mailing address

7400 METRO BLVD SUITE 413
EDINA MN
55439-2316
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-6950
  • Fax: 952-835-0072
Mailing address:
  • Phone: 952-835-6950
  • Fax: 952-835-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3280
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3280
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2929
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number870
License Number StateMN

VIII. Authorized Official

Name: DR. JUDY TIESEL
Title or Position: PRESIDENT
Credential:
Phone: 952-835-6950