| NPI | 1255013504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLETTE R JOHNSON Therapist 320-855-6557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2025-08-04 |