| NPI | 1881690899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRIE A KAMINSKI Credentialing / Billing COO Rdinator 651-789-4039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 800792-1-MHC) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2020-08-22 |