| NPI | 1649644634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LEE KAYE SWANSON Director Of Communications 651-242-9608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3782) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc00241) |
| 106H00000X Marriage & Family Therapist (Licence: MN 920) | |
| 106H00000X Marriage & Family Therapist (Licence: MN 2005) | |
| Enumeration Date | 2015-11-14 |
| Last Update Date | 2016-09-02 |