| NPI | 1699418210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB THOMAS MINNIG Owner/Ladc 651-233-8379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2022-04-20 |