| NPI | 1437636131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COACH NAKUMBE Owner / Clinical Director 612-223-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303344) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN 00935) |
| 101YM0800X Counselor, Mental Health (Licence: MN 00935) | |
| 101YP2500X Counselor, Professional (Licence: MN 00935) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN 00935) | |
| 103TC0700X Psychologist, Clinical (Licence: MN 00935) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN 00935) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN 00935) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN 00935) | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2018-07-25 |