| NPI | 1568033405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW LEUNG Clinic Manager 651-300-9659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2025-06-19 |