| NPI | 1972652725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY L BORSCH Office Manager 612-825-3440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |