| NPI | 1043690555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R STIVER Director / Mental Health Therapist 224-733-1615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 180008203) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-11-18 |