| NPI | 1487811105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONAE VERBENA GUSTAFSON Clinical Psychologist 651-430-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3566) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2010-05-12 |