| NPI | 1750265617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALLORY MEGAN BISHER Owner/Provider 952-737-7596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-10-06 |