| NPI | 1457630634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHELEEN AVILA Licensed Psychologist 612-872-9231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LP 0499) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2011-08-05 |