| NPI | 1801544721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATELYN NICOLE HYDUKE Partner 763-760-0464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2023-03-01 |