| NPI | 1053833517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY ANDERSON Owner 763-412-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc01560) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302306) |
| Enumeration Date | 2017-07-16 |
| Last Update Date | 2024-01-30 |