| NPI | 1760549851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC FRANCIS BOONE Counselor 612-285-2188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 10413) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-08-22 |