| NPI | 1124874458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH NIDES Lpcc 612-419-1159 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2026-10-19 |