| NPI | 1457189037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORDIE LICCIARDI Office Manager 701-580-4091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-07-24 |
| Last Update Date | 2024-07-24 |