| NPI | 1104549047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JAMES PETERSON CEO 651-628-9566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2023-10-24 |