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General NPI Number Information
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NPI Number | 1770975633
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Entity Type | Organization
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Legal Business Name | FAMILY RESTORATION COUNSELING SERVICES
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 1769 BERKELEY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2029
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Country | US
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Telephone | 651-263-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 1769 BERKELEY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2029
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Country | US
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Telephone | 651-263-3035
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. NORMA CADENA DE HINDERER
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Credential | LICSW
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Telephone | 651-263-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11661
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License Number State | MN
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