| NPI | 1902934565 |
|---|---|
| Other Name | INTENSIVE OUTPATIENT CHEMICAL DEPENDENCY PROGRAM RULE 31 |
| Entity Type | Organization |
| Authorized Contact | BRIAN NYSTROM President 651-379-1734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |