| NPI | 1093408932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY REID BRANHAM Owner 763-373-3036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2023-05-26 |