| NPI | 1841529930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SHARON SQUIRE Owner 952-854-2440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN MNLP0204) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2009-12-18 |