| NPI | 1720562812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAISAL DERI CEO 612-282-9151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2018-09-24 |