| 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 |