| NPI | 1083098081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE MAREK Psychotherapist 651-308-0450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 01671) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |