| NPI | 1194989590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY CHARLES GREGORY Licensed Clinical Psychologist 701-213-0426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ND 397) |
| Additional Taxonomies | 251S00000X (Licence: ND 397) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2017-05-08 |