| NPI | 1194156075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA M MOSTOLLER Member 651-368-5080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN 20849) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2013-12-03 |