| NPI | 1750004552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ABI Owner 651-367-9613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2022-12-06 |