| NPI | 1952763351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN JEAN BOOM SHEDLOCK Co Owner 320-266-4535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-08-08 |