| NPI | 1104170810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE LEVESQUE Clinical Supervisor 612-348-2574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 21327) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-11-01 |