| NPI | 1073351078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVIN MILLER Owner 651-325-6329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2025-07-14 |