NPI | 1285074039 |
---|---|
Entity Type | Organization |
Authorized Contact | GLORIA PETERSON Clinician 763-553-0344 |
Organization Subpart ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 00747) |
Enumeration Date | 2013-06-26 |
Last Update Date | 2020-03-31 |