| NPI | 1861727810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW M. EASTWOOD COO 651-777-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN 801109) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2012-02-01 |