| NPI | 1023171006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INDIGO BUTT Billing Department 217-872-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-08-03 |