| NPI | 1326486507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN ELLYN TYSON ROBERTS Owner 612-367-7103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: MN 5330) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2021-02-04 |