| NPI | 1861068009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY ANN HICKS Executive Director 218-760-7889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2021-05-28 |