| NPI | 1063680239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDI D GRAHAM Executive Assistant 217-479-5663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2018-03-22 |