| NPI | 1164224077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMED ALI HUSSEN Manager 320-444-9396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-03-24 |