| NPI | 1417147372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY JEAN LONG Psychologist 651-253-8438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP1680) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2007-07-26 |