Organization
FAMILY REVELATIONS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNIE JEROME MENGE MA. LMFT (OWNER / PARTNER)
(651) 319-6484
Entity
Organization
Contact information
Practice address
1705 COPE AVE E STE I, MAPLEWOOD, MN 55109-2639
(651) 319-6484
(651) 925-0442
Mailing address
1705 COPE AVE E STE I, MAPLEWOOD, MN 55109-2639
(651) 319-6484
(651) 925-0442
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
3335
MO
261QM0850X
Adult Mental Health Clinic/Center
Primary
3335
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
3335
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134490469
—
MN
Enumeration date
05/18/2017
Last updated
06/11/2019
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