| NPI | 1235304981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT EDWARD JOHNSON Licensed Psychologist 651-628-0947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MN LP1796) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |