| NPI | 1578188504 |
|---|---|
| Doing Business As | 10,000 LICKS LLC |
| Entity Type | Organization |
| Authorized Contact | SARAH NEWBERRY DONOVAN Owner 651-278-9567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |