| NPI | 1194836064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL ANTHONY MARTINSON Clinic Director 763-572-2605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN LPC 103) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP 3668) |
| 106H00000X Marriage & Family Therapist (Licence: MN LMFT 1081) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |