| NPI | 1407924780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MISSY BLAIR President 612-227-2829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MN LP3550) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2022-12-12 |