| NPI | 1649564188 |
|---|---|
| Former Legal Business Name | BLUE IRIS CENTER FOR THERAPEUTIC SERVICES, LLC |
| Entity Type | Organization |
| Authorized Contact | GRANT D CHIKAZAWA-NELSON Owner/Psychotherapist 612-655-9776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN 943) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-06-01 |