| NPI | 1124384854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY RAICH Authorized Official 651-456-8912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 18483) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2022-02-08 |