| NPI | 1043398316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNETTE GOULD Office Manager 651-636-0308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MN 2207891) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |