| NPI | 1063173508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRENE MBONE OTTOSON Ap RN, Cnp 651-336-2837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2022-01-06 |