| NPI | 1013507433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMALITA TILLMAN Manager 773-439-9748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-03-31 |