| NPI | 1144023623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA DUPAY ELLISON Owner/Provider 612-964-8477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2025-03-31 |