| NPI | 1306414685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE FULLER President 612-644-3380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-06-14 |