| NPI | 1033811963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISIS MENDOZAGARNICA Clinician/Therapist 224-201-7333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2023-04-02 |