| NPI | 1578054144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH ANN ODOM Sole Member 507-848-1026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN 0219) |
| Enumeration Date | 2018-05-19 |
| Last Update Date | 2018-05-19 |