| NPI | 1356117964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED BOSTROM Chief Executive Officer 952-956-3101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2026-05-05 |