| NPI | 1760088553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL ROSSOW Lpcc 218-428-4956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2024-03-28 |