| NPI | 1023427861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA G BULL Billing Director, Staff Therapist 618-444-8801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180008030) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.008116) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2014-08-12 |