| NPI | 1861914608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD M. WAHL Psychologist 701-415-8271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-07-21 |