| NPI | 1790143378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON LEE MAHLEN Owner Psychologist 612-695-0071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 5600) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2016-04-26 |