| NPI | 1063497345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALIA COLLAZO Ins Coordinator 708-448-8470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071001225) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180002611) |
| 101YM0800X Counselor, Mental Health (Licence: IL 18000637) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071003764) | |
| 104100000X Social Worker (Licence: IL 150008269) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2007-12-11 |