| NPI | 1952566747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUE JACOB THAO Clinician/Owner 651-247-3276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 11769) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2014-05-28 |