| NPI | 1023731452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR PONTILLO Managing Member 224-733-9321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2022-09-21 |