| NPI | 1093486722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVE-LYNN R FELLERSEN Owner 218-606-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2023-02-04 |