| NPI | 1669249579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORDIE M. LICCIARDI Office Manager 701-590-4045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |