| NPI | 1023795739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SETH ERICKSON Clinical Director 618-582-3021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-07-04 |
| Last Update Date | 2024-11-22 |