| NPI | 1801337415 |
|---|---|
| Other Name | THERESA SCULLY |
| Entity Type | Organization |
| Authorized Contact | THERESA E SCULLY Owner/Practioner 701-570-4602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: ND 4970) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ND 4970) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2018-09-13 |