| NPI | 1114083540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY DEMARANVILLE Business Manager 612-522-3945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |