| NPI | 1295304947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL JAMES ANDERSON Clinical Social Worker 612-481-4049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2021-06-17 |