# AUTISM FAMILY THERAPY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194101212
- **Authorized official:** MS. TAMARA FAYE PHILLIPS MA, LMFT (PRESIDENT)
- **Authorized official phone:** (612) 597-0459

## Contact information

- **Practice address:** 12805 HIGHWAY 55, SUITE 402, PLYMOUTH, MN 55441-3859
- **Practice address phone:** (612) 597-0459
- **Mailing address:** 6080 IVES LN N, PLYMOUTH, MN 55442-1241
- **Mailing address phone:** (612) 597-0459

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 2491 | MN | Yes |

## Other

- **Enumeration date:** 07/31/2015
- **Last updated:** 07/31/2015