| NPI | 1093542862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARLA VAN WIENEN Credentialing / Contracting 320-746-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2026-03-10 |