NPI | 1063637684 |
---|---|
Other Name | PORTAGE CRAGIN OUTPATIENT |
Entity Type | Organization |
Authorized Contact | MARK STUTRUD President 847-635-4600 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical |
1041C0700X Social Worker, Clinical | |
207Q00000X Family Medicine | |
363L00000X Nurse Practitioner | |
Enumeration Date | 2007-04-17 |
Last Update Date | 2019-12-31 |