Organization Name: | CEDAR VALLEY CENTER FOR CHILD & FAMILY THERAPY |
NPI Number: | 1164829925 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MEGAN OUDEKERK (CLINIC OWNER) |
Mailing Address: | 7675 Mn 13 W Savage |
State: | MN US |
Postal Code: | 55378 |
Phone Number: | 7632293100 |
Fax Number: | |
NPI Enumeration Date: | 11/21/2014 |
NPI Last Update Date: | 11/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |