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NPI Code Detail

MEDICARE: THE FAMILY DEVELOPMENT CENTER FOUNDATION

MEDICARE: THE FAMILY DEVELOPMENT CENTER FOUNDATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558869644
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE FAMILY DEVELOPMENT CENTER FOUNDATION
Provider Business Mailing Address
First Line : 475 CLEVELAND AVE N STE 316
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-5051
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 475 CLEVELAND AVE N STE 316
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-5051
Country : US
Telephone Number : 651-330-3434
Fax Number : 651-330-3581
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : ALYSSA WRIGHT
Credential :
Telephone Number : 651-330-3434
Provider Enumeration Date : 01/24/2018
Last Update Date : 01/24/2018

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1083263032 — MARGARET WILKINSON LMFT
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Directions to “THE FAMILY DEVELOPMENT CENTER FOUNDATION ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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