| NPI | 1902953169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM TRACY ROSS Program Manager 952-564-6337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TC0700X Psychologist, Clinical | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2018-01-18 |