| NPI | 1912396813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD ERICKSON Owner 218-371-6677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2015-01-15 |