| NPI | 1336791987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CIMENA J GORDON Owner 651-260-9262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-07-14 |
| Last Update Date | 2019-07-14 |