| NPI | 1972379873 |
|---|---|
| Other Name | N/A |
| Entity Type | Organization |
| Authorized Contact | EMILY BARBEE Owner 651-358-5836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2023-11-30 |