| NPI | 1215562921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SURVE Manager 612-396-8305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-04 |