| NPI | 1033600929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY KELLY Manager 773-658-6883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.001074) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2019-06-18 |