| NPI | 1144311184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY DOMINIC Chief Financial Officer 651-365-8217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 800689-2-MHC) |
| Additional Taxonomies | 251B00000X Case Management (Licence: MN 800689-2-MHC) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN 800689-2-MHC) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2008-04-10 |