| NPI | 1427039692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN LYNN HART Psychologist 612-414-3540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN LP 4313) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-08-22 |