| NPI | 1629290762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY BURKETT Office Manager 763-494-4404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 1017289-3-CDT) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |