| NPI | 1376007708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN SHAYLOR ALLEY CEO 763-412-1994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2020-02-11 |