| NPI | 1285352872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LAVALLA Administrator 218-512-0630 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC1900X Psychologist Counseling | |
| 104100000X Social Worker | |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-12-30 |