| NPI | 1669180071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAELENE COLESTOCK Executive Director 651-402-4055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-11-14 |