| NPI | 1104653161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVINA DENEAL BISSONETTE Owner 612-619-0021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 103T00000X Psychologist |
| 207Q00000X Family Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2024-10-08 |