| NPI | 1538777131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN DOUGLAS SMITH Counselor 763-746-6553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2020-07-20 |