| NPI | 1073903886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE ANN UNTIEDT Pscyhologist 763-595-7294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 4599) |
| Enumeration Date | 2015-02-01 |
| Last Update Date | 2015-02-01 |