| NPI | 1760264212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI EMMICK Owner/Operator 651-442-1901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2023-10-19 |