OrganizationActive
Family Based Therapy Associates
NPI 1194762005 · Mental Health Counselor · Coon Rapids, MN
Provider details
- NPI number
- 1194762005
- Entity type
- Organization
- Primary specialty
- Mental Health CounselorBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Randall Wallace, Director(763) 780-1520
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
199 Coon Rapids Blvd Nw
Suite 306
Coon Rapids, MN 55433-5831
Phone: (763) 780-1520
Fax: (763) 780-2114
Street-level locationGet directions
Mailing address
199 Coon Rapids Blvd Nw
Coon Rapids, MN 55433-5831
Registry dates
- Enumerated
- 2006-05-31
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.