| NPI | 1356453211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK W SMITH Owner 612-866-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-03-17 |