| NPI | 1497578439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY DAVIS Owner 612-293-5823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2024-11-07 |