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General NPI Number Information
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NPI Number | 1780015511
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Entity Type | Organization
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Legal Business Name | THE FAMILY DEVELOPMENT CENTER, LLC
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 475 CLEVELAND AVE N SUITE 316
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City | SAINT PAUL
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State | MN
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Zip | 55104-5031
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Country | US
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Telephone | 612-799-0862
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Fax |
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Provider Business Mailing Address
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Address Line | 475 CLEVELAND AVE N SUITE 316
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City | SAINT PAUL
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State | MN
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Zip | 55104-5031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. ALYSSA WRIGHT
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Credential | MA, LMFT
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Telephone | 612-799-0862
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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 | 1978
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1539
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License Number State | MN
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