| NPI | 1821422544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN ROGER WIESE Director 651-785-3920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MN LP 1426) |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2013-08-29 |