| NPI | 1053884023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL KOSKI President 218-606-1797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2021-02-01 |