Organization
AUTISM FAMILY THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMARA FAYE PHILLIPS MA, LMFT (PRESIDENT)
(612) 597-0459
Entity
Organization
Contact information
Practice address
12805 HIGHWAY 55, SUITE 402, PLYMOUTH, MN 55441-3859
(612) 597-0459
Mailing address
6080 IVES LN N, PLYMOUTH, MN 55442-1241
(612) 597-0459
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2491
MN
Other
Enumeration date
07/31/2015
Last updated
07/31/2015
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