| NPI | 1154161131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEJYANA CLARK Owner 763-232-4946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103K00000X Behavior Analyst | |
| 251B00000X Case Management | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2024-06-04 |