| NPI | 1366626095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA M VICTOR Clinical Psychologist 612-636-7915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN 4735) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN 4735) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2007-12-17 |