| 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 |