| NPI | 1134490147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAOMI KUSTER Credentialing Coordinator 701-336-5973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2024-05-09 |