| NPI | 1104354406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNA LYNN KELLY Owner 612-961-1015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN 3192) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2020-10-29 |