| NPI | 1760944615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIANNE M LYSNE Owner 218-770-0593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2019-04-01 |