| NPI | 1114932522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL BROOKE PETERSON Licensed Psychologist 763-595-7294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN LP3201) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-08-22 |