| NPI | 1083385231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY WILSON General Manager 651-259-9727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |