| NPI | 1194127878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH JORDAN-O'DONNELL Owner 763-424-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MN cc00759) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303640) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2014-09-24 |