| Family Based Therapy Associates | |
|
199 Coon Rapids Blvd Nw Suite 306 Coon Rapids MN 55433-5831 | |
| (763) 780-1520 | |
| (763) 780-2114 |
| Full Name | Family Based Therapy Associates |
|---|---|
| Speciality | Counselor |
| Location | 199 Coon Rapids Blvd Nw, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Randall D Wallace (DIRECTOR) |
| Authorized Official Contact | 7637801520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Based Therapy Associates 199 Coon Rapids Blvd Nw Suite 306 Coon Rapids MN 55433-5831 Ph: (763) 780-1520 | Family Based Therapy Associates 199 Coon Rapids Blvd Nw Suite 306 Coon Rapids MN 55433-5831 Ph: (763) 780-1520 |
| NPI Number | 1194762005 |
|---|---|
| Provider Enumeration Date | 05/31/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2264432681 |
|---|---|
| Medicare Enrollment ID | O20070110000019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194762005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Robert S Lininger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851462907 PECOS PAC ID: 1658319298 Enrollment ID: I20050422000847 |
| Provider Name | Kristi M Johnson Zempel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902869340 PECOS PAC ID: 9234167701 Enrollment ID: I20050727000522 |
| Provider Name | Timothy M Day |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215023304 PECOS PAC ID: 3274547146 Enrollment ID: I20060130000890 |
| Provider Name | Allyson M Hayward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275516817 PECOS PAC ID: 2860406501 Enrollment ID: I20060320000453 |
| Provider Name | Sheila K Forbes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699876144 PECOS PAC ID: 8628078946 Enrollment ID: I20070125000315 |
| Provider Name | Agnes M Boksa |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437224839 PECOS PAC ID: 9537258140 Enrollment ID: I20071205000196 |
| Provider Name | Eric Joseph Trudell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598197865 PECOS PAC ID: 7618103342 Enrollment ID: I20131202000362 |
| Provider Name | Tamera D Graziano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841578036 PECOS PAC ID: 1557524394 Enrollment ID: I20140107000724 |
| Provider Name | Linda J Buchs Hammonds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942318175 PECOS PAC ID: 2466409644 Enrollment ID: I20150610002674 |
| Provider Name | Lisa M Vanbaalen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679636799 PECOS PAC ID: 9830490465 Enrollment ID: I20151223001453 |
| Provider Name | Heather M Wakefield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538682182 PECOS PAC ID: 3375816531 Enrollment ID: I20170911000096 |
| Provider Name | Ami M Cantway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376186320 PECOS PAC ID: 7618309493 Enrollment ID: I20191115002312 |
| Provider Name | Jennifer L Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487299293 PECOS PAC ID: 0547696775 Enrollment ID: I20200207000713 |
| Provider Name | Nichole A Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568241016 PECOS PAC ID: 7315394269 Enrollment ID: I20231114002675 |
| Provider Name | Jon A Marlton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1104162163 PECOS PAC ID: 5294186896 Enrollment ID: I20240108005797 |
| Provider Name | Marnie L Harper |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760915565 PECOS PAC ID: 1658722145 Enrollment ID: I20240109003075 |
| Provider Name | Rikki R Alstad |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649862624 PECOS PAC ID: 5092168146 Enrollment ID: I20240125001705 |
| Provider Name | Jeffrey A Brown |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730163478 PECOS PAC ID: 2769835305 Enrollment ID: I20240130002649 |
| Provider Name | Nohemi E Weekley |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720477300 PECOS PAC ID: 6800249251 Enrollment ID: I20240201001409 |
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