| NPI | 1053760108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROVER GRAY WILSON Owner/Operator 773-373-9175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149015915) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2021-05-15 |