| NPI | 1164923843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON ECKERMAN Clinical Psychologist 651-204-4034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN LP5825) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2018-02-27 |