| 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 |