| NPI | 1598427890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA MARIE JOHANSON Manager 605-864-0891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2021-10-13 |