| NPI | 1508168337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI LYNN WALDOCH Lmft 763-291-5505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: MN 1894) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN 1894) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN 1894) | |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2010-11-30 |