| NPI | 1821698671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC AUSTIN JOHNSON Owner 218-481-0220 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |