| NPI | 1144306614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFRY G FORD Licensed Psycholgist 651-483-2522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LP0502) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-22 |