| NPI | 1588206940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA PAIGE ROGERS Co Owner 651-503-7391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2020-04-08 |