| NPI | 1811412711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON DEAN REED Clinical Director 612-309-1022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2017-08-11 |