| NPI | 1740559699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE KEITH THORDAL Executive Director 651-225-0854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP1135) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |