| NPI | 1104322049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNDA KOEHLER President 612-356-6878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN 2667) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2019-06-11 |