| NPI | 1407943087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN ELIZABETH JOHNSON President 651-402-6209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN LP4356) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MN LP4356) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP4356) | |
| 103TC0700X Psychologist, Clinical (Licence: MN LP4356) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP4356) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MN LP4356) | |
| 103T00000X Psychologist (Licence: MN LP4356) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN LP4356) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-07-21 |