NPI | 1558012286 |
---|---|
Entity Type | Organization |
Authorized Contact | GEORGEANNA INGERSOLL LEWIS Therapist/Owner 612-239-2796 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X |
Additional Taxonomies | 251S00000X Community/Behavioral Health |
261QM0850X Clinic/Center, Adult Mental Health | |
261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
Enumeration Date | 2022-01-13 |
Last Update Date | 2022-01-13 |