| NPI | 1396451241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DE ELLA DAWN WILCOX Manager/Owner 218-639-2805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2025-02-24 |