| NPI | 1154363414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN A. JACOBSON Clinical Psychologist 763-595-7294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN LP0158) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-08-22 |