| NPI | 1124593090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AKEYA BOLDEN Owner 763-670-2216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2018-10-08 |