Organization
FAMILY LIFE MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SULLIVAN LICSW (EXECUTIVE DIRECTOR)
(763) 427-7964
Entity
Organization
Contact information
Practice address
1930 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-4708
(763) 427-7964
(763) 427-7976
Mailing address
1930 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-4708
(763) 427-7964
(763) 427-7976
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04358FA
BCBS
MN
01
—
1023452
PREFERRED ONE
MN
01
—
106982
BHP U-CARE
MN
01
—
3868
HEALTH PARTNERS
MN
01
—
62-20356
UBH
MN
Enumeration date
07/05/2005
Last updated
08/22/2020
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