| NPI | 1013767680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WIESMAN Owner 309-242-2172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-03-25 |