Organization
YOUTH AND FAMILY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA JANE MERRIMAN MA LP (CO CEO)
(612) 722-9612
Entity
Organization
Contact information
Practice address
4405 E LAKE ST, MPLS, MN 55406
(612) 722-9612
Mailing address
4405 E LAKE ST, MPLS, MN 55406
(612) 722-9612
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2536
MN
Other
Enumeration date
10/18/2006
Last updated
08/22/2020
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