| NPI | 1619059755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA SHOSTED Owner 320-253-3715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2023-05-15 |