Provider Demographics
NPI:1972323319
Name:FAMILY TREE BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:FAMILY TREE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSOB
Authorized Official - Middle Name:HASHI
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-636-1186
Mailing Address - Street 1:4293 144TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068
Mailing Address - Country:US
Mailing Address - Phone:612-636-1186
Mailing Address - Fax:
Practice Address - Street 1:4293 144TH STREET WEST
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068
Practice Address - Country:US
Practice Address - Phone:612-636-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty