| NPI | 1548637507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT MILES Licensed Psychologist 1320-247-4737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN LP5676) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2015-08-26 |