| NPI | 1235249541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RICHARD FOWLER President 952-545-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1765) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |