| NPI | 1639041064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEO NICHOLAS BUKOVSAN Mental Health Clinician 651-485-6648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2025-09-23 |