| NPI | 1891713681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY JO CLUTE Office Manager 651-294-3436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MN 1339) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN 1339) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-08-22 |