| NPI | 1811487887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER VAUGHN Lmft 218-820-6626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-05-15 |