| NPI | 1235949553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CLOYD Secretary 763-330-4953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2025-01-09 |
| Last Update Date | 2025-03-07 |