| NPI | 1598350092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNA SEVERSON Owner 320-491-1892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2021-03-05 |