| NPI | 1780600189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CARL LYSNE Psychologist 218-998-3123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN 4575) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MN 00257) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2013-05-02 |