| NPI | 1659662971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMISON WAYNE OTTUM Psychotherapist/Clinic Director 952-451-1547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 18010) |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-26 |