| NPI | 1992430045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JOHN MONTVILLE Chief Medical Officer 612-805-7008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 101YM0800X Counselor, Mental Health | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2025-07-24 |