| NPI | 1477859940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY ANN WADE Owner 612-385-6392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN LP5259) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2011-02-01 |