Healthcare Provider Details

I. General information

NPI: 1467069229
Provider Name (Legal Business Name): FAMILY THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W 76TH ST STE 250
EDINA MN
55435-5116
US

IV. Provider business mailing address

4444 W 76TH ST STE 250
EDINA MN
55435-5116
US

V. Phone/Fax

Practice location:
  • Phone: 952-262-0603
  • Fax:
Mailing address:
  • Phone: 952-262-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ZAHRA DIRIR
Title or Position: MANAGER
Credential:
Phone: 952-262-0603