| NPI | 1104408509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENAY L BUICE CEO 763-807-5254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2021-04-25 |
| Last Update Date | 2021-04-25 |