| NPI | 1518627736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABDULKADIR ALI OMAR Manager 612-472-5645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2024-05-10 |