NPI | 1225308786 |
---|---|
Entity Type | Organization |
Authorized Contact | RUTH RUSSO Business Office Manager 952-224-2990 |
Organization Subpart ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MN lp3228) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302633) |
101YA0400X Counselor, Addiction (Substance Use Disorder) | |
Enumeration Date | 2011-12-30 |
Last Update Date | 2011-12-30 |