| NPI | 1174738215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND N SAMPSON CEO Owner 218-262-4453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1373) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |