| NPI | 1164891180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN SEPPALA Chief Medical Officer 651-213-4825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2015-09-21 |