| NPI | 1265791503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI KAY WORRELL Executive Director 651-760-3109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2020-08-24 |