| NPI | 1164711735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ELMER SUNDBY Executive Director 651-636-5120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MN LP4114) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN MN06627) |
| 103TC0700X Psychologist Clinical (Licence: MN LP4223) | |
| 103TC1900X Psychologist Counseling (Licence: MN LP0816) | |
| 103TC1900X Psychologist Counseling (Licence: MN LP5213) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2025-05-14 |