| NPI | 1023723004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA R WIENS Owner 651-283-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2023-01-13 |