| NPI | 1417587403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEA MEGEN MCMARTIN Director 651-587-6826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-01-19 |
| Last Update Date | 2020-03-01 |