Provider Demographics
NPI:1427140193
Name:FAMILY AND ADOLESCENT THERAPEUTIC SERVICES, INC.
Entity type:Organization
Organization Name:FAMILY AND ADOLESCENT THERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, LICSW
Authorized Official - Phone:651-784-7680
Mailing Address - Street 1:P.O. BOX 533
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014
Mailing Address - Country:US
Mailing Address - Phone:651-784-7680
Mailing Address - Fax:
Practice Address - Street 1:7578 LEONARD AVE.
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014
Practice Address - Country:US
Practice Address - Phone:651-784-7680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty