| NPI | 1548812969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA PETERSON Owner 612-385-4566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2024-12-02 |