| NPI | 1255041992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE WAINRIGHT-TADYCH CEO 320-290-0693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |