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General NPI Number Information
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NPI Number | 1194815969
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Entity Type | Organization
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Legal Business Name | COMMUNITY BASED FAMILY THERAPY ASSOCIATES, INC.
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/25/2024
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Provider Practice Location Address
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Address Line | 1937 WOODLANE DR STE 206
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City | WOODBURY
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State | MN
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Zip | 55125-4044
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Country | US
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Telephone | 651-206-3584
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Fax | 651-501-7649
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Provider Business Mailing Address
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Address Line | 1937 WOODLANE DR STE 206
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City | WOODBURY
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State | MN
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Zip | 55125-4044
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Country | US
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Telephone | 651-206-3584
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Fax | 651-501-7649
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Authorized Official
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Title or Position | CEO
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Name | TERRI TAYLOR
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Credential | MS, LMFT
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Telephone | 651-206-3584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1430
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License Number State | MN
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