| NPI | 1417283946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ANN LUNDHOLM-EADES Owner 651-288-0332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TF0000X Psychologist, Family | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 106H00000X Marriage & Family Therapist (Licence: MN 942) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2009-10-18 |
| Last Update Date | 2019-01-21 |