| NPI | 1568430635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIC KOSKI Authorized Official 218-606-1797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP2873) |
| 1041C0700X Social Worker, Clinical (Licence: MN 8526) | |
| 106H00000X Marriage & Family Therapist (Licence: MN 64) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-10-27 |