| NPI | 1427841675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INTESAR KASIM Owner 612-217-3689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-05-28 |