| NPI | 1356137509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE ANDERSEN Billing Regulatory Manager 218-679-1320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-04-15 |