| NPI | 1447852637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISE AILEEN SMITH Hipaa Credentialing Specialist 952-213-4114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2020-11-12 |