| NPI | 1437691128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA HOLLIBUSH Outpatient Mental Health Therapist 651-243-8967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 18910) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: WI 6925) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2016-11-10 |