| NPI | 1134012529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAHADO ONWUKWE Authorized Official 320-980-6031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-07-08 |