| NPI | 1215258140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY DEPREKEL Clinical Director 952-934-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP 3332) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2010-06-15 |