| NPI | 1396084901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY KAY HANSEN Owner 612-532-6741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3954) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN LSW5063) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2014-04-02 |