| NPI | 1609876051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN JAEHNE Clinical Director 651-224-0614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MN 800960-1-MHC) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2020-08-22 |