| NPI | 1598186330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELLIE JEAN BACIGALUPO Administrator 866-522-2472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN LPCC00186) |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2022-03-30 |