Family Based Therapy Associates
NPI 1194762005ActiveOrganization· Counselor, Mental Health· Coon Rapids, MN
Counselor, Mental Health in Coon Rapids, Minnesota, registered in NPPES in May 2006. The authorized official on file is Randall D. Wallace, LP, Director. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1194762005 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 31, 2006 |
| Last updated in NPPES | Aug 22, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Mental Health Primary | 101YM0800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MN) |
|---|
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