| NPI | 1205025442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ANN RUSSELL-MARTIN Owner 218-831-1871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2024-10-30 |