| NPI | 1760723563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J. SHEA License Pyschologist, Owner 612-871-2165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN LP2029) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2013-03-05 |