| NPI | 1558167445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEO SENGSAVANG Credentialing Agent 612-234-1823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2025-02-20 |
| Last Update Date | 2025-02-20 |