| NPI | 1912052952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY TIESEL President 952-835-6950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: MN 3280) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 3280) |
| 1041C0700X Social Worker, Clinical (Licence: MN 2929) | |
| 106H00000X Marriage & Family Therapist (Licence: MN 870) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |