| NPI | 1851036123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE ANDERSEN Revenue Generation Manager 218-679-1320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2023-07-17 |