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NPI Code Detail

MEDICARE: NORTHEAST YOUTH & FAMILY SERVICES

MEDICARE: NORTHEAST YOUTH & FAMILY SERVICES
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

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

General Provider Information

NPI Number : 1639275852
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST YOUTH & FAMILY SERVICES
Provider Business Mailing Address
First Line : 3490 LEXINGTON AVE N STE 205
Second Line :
City : SHOREVIEW
State : MN
Zip : 55126-8044
Country : US
Telephone Number : 651-486-3808
Fax Number : 651-486-3858
Provider Business Practice Location Address
First Line : 3490 LEXINGTON AVE N
Second Line : SUITE 205
City : SHOREVIEW
State : MN
Zip : 55126-8074
Country : US
Telephone Number : 651-486-3808
Fax Number : 651-486-3858
Authorized Official
Title or Position : LICSW
Name : ANGELA K LEWIS-DMELLO
Credential : LICSW
Telephone Number : 651-379-3404
Provider Enumeration Date : 09/15/2006
Last Update Date : 01/20/2026

Similar Medicare Providers

1417014168 — CAROLYN LARSON LMFT
Practice Location Address:
3490 LEXINGTON AVE N
SHOREVIEW, MN
55126-8074
Practice Phone: 651-486-3808
Practice Fax: 651-486-3858
1497812283 — ELAINE MOORE MA, LP
Practice Location Address:
3490 LEXINGTON AVE N
SHOREVIEW, MN
55126-8074
Practice Phone: 651-486-3808
Practice Fax: 651-486-3858
1184781643 — ANGELA SIEGLE LPC
Practice Location Address:
3490 LEXINGTON AVE N
SHOREVIEW, MN
55126-8074
Practice Phone: 651-486-3808
Practice Fax: 651-486-3858
1982761342 — JEFF WORLEY LICSW
Practice Location Address:
3490 LEXINGTON AVE N
SHOREVIEW, MN
55126-8074
Practice Phone: 651-486-3808
Practice Fax: 651-486-3858
1225256316 — JEANNE L GUNVALSON M.S., CCC
Practice Location Address:
3490 LEXINGTON AVE N , SUITE 305
SHOREVIEW, MN
55126-8074
Practice Phone: 651-639-0942
Practice Fax: 651-639-1718
1396926903 — JASON MCEWEN LMFT
Practice Location Address:
3490 LEXINGTON AVE N
SHOREVIEW, MN
55126-8074
Practice Phone: 651-486-3808
Practice Fax: 651-486-3858

Directions to “NORTHEAST YOUTH & FAMILY SERVICES ” Practice Location

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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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