| NPI | 1013162304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRAN ALLISON GREEN Controller 217-446-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 04020) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 04020) |
| 103T00000X Psychologist (Licence: IL 04020) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 04020) | |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2008-12-02 |