| NPI | 1164829925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN OUDEKERK Clinic Owner 763-229-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2014-11-21 |