| NPI | 1245619626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WILLIAM ANDERSON President 218-326-5694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN CC00977) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 301946) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 302045) | |
| 106H00000X Marriage & Family Therapist (Licence: MN 1451) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2015-05-19 |