Organization
NORTHEAST YOUTH & FAMILY SERVICES
Active
Parent organization
NORTHEAST YOUTH & FAMILY SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST YOUTH & FAMILY SERVICES
Authorized official
MS. LISA M PAQUET BA (CLINIC OPERATIONS MANAGER)
(651) 379-3443
Entity
Organization
Contact information
Practice address
1280 N BIRCH LAKE BLVD, WHITE BEAR LAKE, MN 55110-6708
(651) 429-8544
(651) 407-5301
Mailing address
3490 LEXINGTON AVE N STE 205, SHOREVIEW, MN 55126-8044
(651) 486-3808
(651) 486-3858
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A880726400
UPI
MN
Enumeration date
09/27/2018
Last updated
09/27/2018
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