| NPI | 1730302894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE M GORDON CEO 763-754-1531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN 3751) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 3751) |
| 103TC0700X Psychologist, Clinical (Licence: MN 3751) | |
| 103TC1900X Psychologist, Counseling (Licence: MN 3751) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN 3751) | |
| 103TF0000X Psychologist, Family (Licence: MN 3751) | |
| 1041C0700X Social Worker, Clinical (Licence: MN 7835) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |