| NPI | 1730452681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK E ANDERSON Clinical Psychologist 651-482-9361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP3081) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-02-22 |