| NPI | 1386016822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY LIVELY President 651-789-8769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2025-08-20 |