| NPI | 1063744662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRA JEAN HECKENLAIBLE-GOTTO Licensed Psychologist 507-822-3177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 4507) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2010-02-06 |
| Last Update Date | 2010-02-06 |