| NPI | 1609008010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLYN ELVERA NELSON Sole Proprietor 651-341-9667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP 3967) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2009-08-18 |