| Professional Family Based Division | |
|
1900 Silver Lake Rd. Nw #110 New Brighton MN 55112 | |
| (651) 628-9253 | |
| (651) 631-8789 |
| Full Name | Professional Family Based Division |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1900 Silver Lake Rd. Nw, New Brighton, Minnesota |
| Authorized Official Name and Position | Brian A. Nystrom (CEO) |
| Authorized Official Contact | 6516289566 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Family Based Division 1900 Silver Lake Rd. Nw #110 New Brighton MN 55112 Ph: (651) 628-9566 | Professional Family Based Division 1900 Silver Lake Rd. Nw #110 New Brighton MN 55112 Ph: (651) 628-9253 |
| NPI Number | 1790872562 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 03/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790872562 | NPI | - | NPPES |
| 77519900 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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