| NPI | 1982900510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD T. LORENZ Owner 952-443-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1764) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MN LP5754) |
| Enumeration Date | 2011-01-29 |
| Last Update Date | 2016-08-18 |