| 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 |