| NPI | 1134691975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN LOUIS BEULKE Owner/CFO 612-240-8813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2022-08-02 |