| NPI | 1366874299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF W SHIVELY President 612-723-0408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 18053) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2013-08-03 |