| NPI | 1548120876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE VLACH Owner/Provider 651-307-8672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2025-11-18 |