| NPI | 1013747989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATINA RUSSELL Credentialing Specialist 312-663-1130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-08-06 |