| NPI | 1164934303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD LEE Executive Director 320-202-2033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 800356-1-MHC) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2018-08-20 |