| NPI | 1619314614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLE BUCHTEL Clinical Supervisor 612-462-3310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 167129) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2013-05-30 |