| NPI | 1811162746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY MARGARET ANDERSEN Clinical Nurse Specialist 952-322-8532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |