| NPI | 1881109544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN ELIZABETH RULLO Psychologist/Manager 612-991-3042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |