NPI | 1740576354 |
---|---|
Entity Type | Organization |
Authorized Contact | JERRY LEE HOLT Program Director 763-559-5677 |
Organization Subpart ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 00416) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302560) |
Enumeration Date | 2011-06-22 |
Last Update Date | 2012-07-19 |