| NPI | 1851737910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD HERMAN Owner 612-223-0797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN LADC 302934) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2013-05-16 |