| NPI | 1790212926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNIE JEROME MENGE Owner / Partner 651-319-6484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN 3335) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 3335) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN 3335) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2019-06-11 |