| NPI | 1639343783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE C PETERSON Therapist 612-203-2961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1315) |
| Enumeration Date | 2008-04-19 |
| Last Update Date | 2021-06-01 |