| NPI | 1841002151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIAD WARSAME Owner 612-607-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-01-23 |
| Last Update Date | 2025-01-23 |