| NPI | 1881575207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI LISTUG-LUNDE Owner 320-448-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2025-09-11 |
| Last Update Date | 2025-10-27 |