| NPI | 1073072260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESIA AYCOCK Administration/Mhp 763-439-2588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QC1800X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2019-03-18 |