| NPI | 1043700800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE JONG KOCH Owner 612-234-1072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2025-11-07 |