| NPI | 1053018242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDEN FASKEN Chief Operating Officer 815-780-0690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2024-04-17 |