NPI | 1912798174 |
---|---|
Entity Type | Organization |
Authorized Contact | CASSIANN M PROCENKO Clinical Director 320-310-8895 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2025-05-15 |
Last Update Date | 2025-05-15 |