| NPI | 1780094904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA MARIE MITCHELL Therapist 612-554-6069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1709) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2014-04-28 |