| NPI | 1881035624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA RUTH STREITMAN Owner 952-935-3152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN LP0666) |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: MN LP0666) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN LP0666) | |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2013-07-09 |