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THERAPEUTIC SERVICES AGENCY, INC.220 Railroad St. S.E. ? Pine City, MN 55063 ? (320) 6297600 ? Depot Fax (651) 9250071 ? www.hoperealized.comFBS and Outpatient Services Referral Informational of Referral:
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npinocomcounselor1821076597-formrapeuticformrapeutic services agency inc is likely a fictitious or placeholder name for a specific therapeutic services agency that may be involved in providing mental health or counseling services, associated with a unique National Provider Identifier (NPI).
Typically, healthcare providers, including agencies offering therapeutic services, who are seeking to participate in Medicaid, Medicare, or other insurance programs would be required to file this form.
To fill out the form, gather necessary information about your agency, including the NPI number, services offered, contact information, and any relevant operational details, then follow the specific instructions provided with the form.
The purpose of the form is to register the agency with appropriate health services authorities and to ensure compliance with regulations governing therapeutic service provisions.
Information such as agency name, NPI number, address, service types, and provider affiliations must typically be reported on the form.
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