| NPI | 1467324459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABBY LARSON Owner 651-260-0761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-09-19 |
| Last Update Date | 2025-10-19 |