| NPI | 1578007969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KESHA GREEN Director 763-355-5461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 25186) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 3003) |
| 251S00000X (Licence: MN 3003, 25186) | |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2017-02-08 |