| NPI | 1104573195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMED ISMAEL Supervisor 612-442-6011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2024-01-29 |