| NPI | 1699278283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY M BOOZELL Credential Specialist 218-232-0856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc01151) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302869) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2024-05-16 |