| NPI | 1093479057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER MAGELKY Billing Consultant 218-329-2705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2022-01-20 |