| NPI | 1841359270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY RICHARD BENGTSON President 855-454-2463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc00105) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-04-15 |