| NPI | 1174905178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE JOANNE WIGHT Lmft 612-978-6219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 2759) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2015-06-25 |