| NPI | 1972041937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE SUAREZ Licensed Associate Mft 612-220-1642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 3352) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |