| NPI | 1477221075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LARSON Owner 507-301-6741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2021-08-31 |