| NPI | 1467805721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE MARY LAFFERTY BOERBOOM Psychologist 612-998-6787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP3481) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |