Organization
FAMILY INNOVATIONS, INC.
Active
Other names
LifeStance Health
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PARDO (CHIEF LEGAL OFFICER)
(206) 399-1493
Entity
Organization
Contact information
Practice address
1833 3RD AVE, ANOKA, MN 55303-2424
(763) 421-5535
(763) 433-0226
Mailing address
1833 3RD AVE, ANOKA, MN 55303-2424
(763) 421-5535
(763) 433-0226
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026665500
—
MN
01
—
04033007
METROPOLITAN HEALTH PLAN
MN
01
—
086M6FA
BLUE CROSS BLUE SHIELD
MN
01
—
211588
COMPSYCH EAP
MN
01
—
300P0FA
BLUE CROSS BLUE SHIELD
MN
01
—
48G90FA
BLUE CROSS BLUE SHIELD
MN
01
—
81312
HEALTH PARTNERS
MN
Enumeration date
01/02/2007
Last updated
03/20/2024
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