| NPI | 1649715400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME MCNATT-SERBUS Therapist 952-300-1039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: 16509) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2018-01-10 |