| NPI | 1063382224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH STANFORD Owner 815-985-7381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-11-11 |
| Last Update Date | 2026-04-14 |