| NPI | 1477829935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY RUSSELL HUNTER Therapist 651-269-0485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1605) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-03-29 |