| NPI | 1043595564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN LAUBE Executive Director 952-448-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5121) |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2011-10-15 |