| NPI | 1164569679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY A JOHNSON Chief Operating Officer 612-884-0802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2013-02-20 |