| NPI | 1841698339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD FITZGERALD LEWIS Executive Director 952-933-4808 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 1075563-2-CDT) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: MN 1075563) |
| 101Y00000X Counselor (Licence: MN 1075563-2-CDT) | |
| 101YM0800X Counselor, Mental Health (Licence: MN 1075563-2-CDT) | |
| 101YP1600X Counselor, Pastoral (Licence: MN 1075563-2-CDT) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MN 1075563-2-CDT) | |
| 103TC0700X Psychologist, Clinical (Licence: MN 1075563-2-CDT) | |
| 103TC1900X Psychologist, Counseling (Licence: MN 1075563-2-CDT) | |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2017-03-06 |